- How is the mammary gland
- Normal discharge
- Physiological causes of discharge
- Pathological causes of discharge from the chest
- What are the discharge from the nipples
- brown discharge
- White discharge
- Purulent discharge
- yellow discharge
- Green discharge
- Discharge during pregnancy
- Colostrum before menstruation
- What secretions do not need to be afraid
- Causes of discharge from the nipples in men
- What to do
- Breast self-examination
- How is a diagnosis made with discharge from the nipples?
- Methodology of cytological research
- Study preparation
- Interpretation of the cytological conclusion
- Conservative therapy
The excretion of secretions from the mammary glands occurs through the same ducts that excrete breast milk during lactation. In non-nursing women, these ducts constantly contain some amount of fluid, which can sometimes be released from the nipples.
What does the appearance of discharge from the nipples mean?
Of course, any woman should be alerted by the sudden appearance of discharge from one or both nipples (secernation), if this has not been observed before. The normal color of the discharge may vary from clear to yellowish, and the consistency may be very runny or slightly slimy.
Expert opinion The main concern of most women who have experienced secernation is that this condition may be due to oncological processes. However, it is believed that cancer is rarely accompanied by discharge from the nipples, so do not panic.
How is the mammary gland
The mammary gland consists of 15-20 lobules, inside which colostrum and milk are produced. These structures are equipped with tubes - milk ducts, which merge with each other and open on the nipple with 5-8 milk holes. Between the lobules is fatty and connective tissue.
The hormone prolactin, produced by the pituitary gland, an appendage of the brain located in the notch of the skull, the Turkish saddle, regulates the work of the organ. It is this substance that is responsible for the growth of the glands, their development, preparation for pregnancy and the appearance of milk. During pregnancy, the amount of prolactin increases, the breast begins to produce colostrum, and later milk. After feeding is completed, lactation stops.
A small amount of clear liquid - a secret secreted outside of feeding, is absorbed inside the ducts and practically does not stand out.
The female breast contains milk ducts, which are located between the fibrous and adipose tissue. Each canal has an opening at the top of the nipple. For all women, the number of ducts is individual, but the maximum number can be up to fifteen. Through the lactiferous ducts, not only milk and colostrum are produced, but also physiological secretion.
In the absence of diseases, the influence of external negative factors for whitish, transparent discharge from the mammary glands, the following condition is inherent:
- scarce and plentiful;
- thick and watery;
- viscous or slimy.
Any homogeneous consistency of secretion from the channels is the norm, but only against the background of a transparent shade of liquid and a small volume. If there is too much discharge, it is not recommended to postpone a visit to the mammologist.
For a certain condition, there are indicators of the norm of a physiological secret:
- Scanty, thick (one or two drops). It is noted with pressure on the chest in young girls and nulliparous women a few days before menstruation and during increased sexual arousal.
- Not very plentiful, liquid. They are characteristic of older women and women who have given birth, but the appearance of a thick liquid is not excluded.
- Viscous. Colostrum occurs during gestation, feeding the child and for several years after the cessation of lactation (individual indicator).
Physiological causes of discharge
Physiological features explain the discharge:
- Some time after the end of feeding. Allocations can be observed for the next two or three years. It depends on the age of the woman and the number of pregnancies.
- During pregnancy. In the female breast, preparations are made for the birth of the baby and its feeding. The glands are trained to make milk and excrete it. Similar processes occur in the third, final trimester. The increased tone of the uterus stimulates the release of a cloudy white or yellowish liquid from both mammary glands.
- When using contraceptives. Oral contraceptives contain hormones that stimulate lactation. Allocations should disappear after the abolition of contraceptives. They should be replaced with a different kind. But it is wise to do this only on the advice of a doctor.
- After an abortion. The presence of secretions and their duration are determined by the period at which the artificial termination of pregnancy occurred. They can disturb a woman from several days to a month.
The allocation of a small amount of clear liquid is possible during the treatment with hormonal drugs, the use of antidepressants. The reason can be too tight bra, and physical overload.
Pathological causes of discharge from the chest
Discharge from the nipples may be normal (physiological), in which case the discharge stops on its own. We must try not to stimulate the nipples, as this can slow down the disappearance of the discharge.
In addition to the physiological causes of discharge from the chest, there are also pathological ones:
Milk duct ectasia. Milk duct ectasia is one of the most common causes of abnormal discharge from the chest. Inflammation occurs in one or more ducts, the duct becomes clogged with thick, sticky green or black secretions. Most often, ectasia of the milk ducts occurs in women 40-50 years old. Some improvement can be achieved by using warm compresses and taking aspirin or ibuprofen. In some cases, antibiotics are prescribed if an infection is suspected. If conservative treatment fails, surgery may be required.
Intraductal papilloma. An intraductal papilloma is a small, usually benign tumor that develops in the lactiferous duct close to the nipple. Intraductal papilloma is most often found in women 35-55 years old. The cause of its occurrence is unknown, and the risk factors for the appearance of this tumor are also unknown. Discharge from the chest with intraductal papilloma may be bloody, usually they have a thick consistency. Secretions are secreted from one duct when the nipple is stimulated. Usually the tumor can be palpated inside the areola.
For diagnosis, ultrasound of the areola and surrounding tissues is usually performed. Treatment - surgical removal of the duct and histology of the tumor (to exclude its malignancy).
Galactorrhea. With galactorrhea, discharge from the nipple is usually white or clear, less often yellow or green. Discharge may be from one or both mammary glands. The cause of galactorrhea is an increase in the level of prolactin in the body. Prolactin is a special hormone produced by the brain to stimulate milk production after the baby is born. The reasons for the increase in prolactin levels can be different: taking contraceptives, decreased thyroid function, a pituitary tumor (prolactinoma), chronic nipple stimulation, etc.
Injury. Blunt trauma to the breast (such as hitting the steering wheel in an accident) can result in discharge from one or both breasts. The discharge may be clear, yellow, or bloody. The outflow of fluid occurs from several ducts and occurs spontaneously, without stimulation.
Abscess. An abscess is a collection of pus. Most often, abscesses of the mammary glands occur in lactating women. Cracks in the nipple allow bacteria to enter the breast tissue and cause an infection. In the discharge from the chest, an admixture of pus sometimes appears, the breast increases in size, becomes painful, hot, and redness of the skin appears. Treatment - surgical (opening of the abscess) + antibiotics.
Mammary cancer. Discharge from the breast is usually rarely a symptom of cancer, however an intraductal tumor or invasive cancer may cause discharge. Alarming signs are the presence of spontaneous bloody discharge from only one breast - in this case, you should urgently consult a mammologist.
A special form of breast cancer, Paget's disease, can also lead to nipple discharge. Paget's disease is rare, accounting for 1-4% of all breast cancers. Symptoms are as follows: burning, itching, redness, peeling of the skin of the nipple and areola. Bloody discharge from the nipple may join, the nipple may “pull” inward. Diagnosis requires an areola biopsy. The usual treatment is to remove the entire breast (mastectomy), sometimes it is possible to remove only the tumor and some of the surrounding tissue. After surgery, chemotherapy and radiation may be required.
Mastitis is an acute infectious disease. It proceeds difficult, accompanied by severe pain, intense secretions of a green and even brown hue, pus appears. A woman suffers from fever, the skin of the chest turns red, strongly compacted, flaky. Causes:
- improper pumping during feeding - there is no constant frequency, milk stagnation occurs;
- cracks in the nipples;
- associated infection in the body;
- lack of hygiene.
In this case, it is necessary to refuse breastfeeding, immediately consult a doctor, start taking antibiotics. There is a risk of abscess formation.
What are the discharge from the nipples
Fluid that emerges from the nipples with or without pressure may vary in color and consistency. Let's look at the most common selection options:
If a woman has breast pain and black or brown discharge from the nipple, the reason may be the development of malignant neoplasms. Also, the appearance of dark secretions may be due to the presence of blood in the ducts - a similar situation is usually observed with closed chest injuries, papilloma.
White discharge from the chest during pregnancy, as well as during lactation, is considered the norm. If they appear outside of pregnancy and lactation, then this may be a symptom of galactorrhea.
Accumulations of pus in the milk ducts are usually caused by infection inside the duct. Most often occurs after childbirth, while breastfeeding.
The clear liquid that flows from the nipples appears as a result of the release of blood plasma from the vessels into the ducts. The symptom may have physiological prerequisites: discharge is occasionally observed during sexual intercourse, when wearing tight bras. The outflow of serous fluid is typical for the initial period of inflammatory processes, light bruises of the chest.
Colostrum-like discharge (galactorrhea). The secret in its chemical composition is breast milk, the pituitary hormone prolactin is responsible for its synthesis. The outflow of colostrum from one or two mammary glands is caused by excessive stimulation of the glandular apparatus. An increase in the production of prolactin occurs both with damage to the pituitary gland, and with the indirect effect of various hormonal substances.
One possible cause of such discharge from the nipples is ectasia, or enlargement of the milk ducts. Also, sometimes a greenish or yellow liquid can also be released during mastopathy.
In some cases, the discharge has a bright red or burgundy-brown color, which depends on the age of bleeding. Sometimes ichor flows from the nipple. Blood is released when benign papillomas are injured, malignant tumors decay. After a blow to the chest area, the glandular lobules and ducts are damaged, which is also manifested by bleeding.
The appearance of green discharge from the nipples when pressed may be a sign of mastopathy. Usually in this case, when pressed, a thick mucous liquid appears. Also often there is a painful swelling of the breast.
Discharge during pregnancy
Immediately after conception, a woman's body changes - the level of sex hormones increases, the breast increases, a venous network appears. From the nipples, a yellowish or white substance begins to ooze - colostrum, which precedes the production of milk. The phenomenon is observed more often before childbirth, but can occur as early as 20-23 weeks of pregnancy. The glandular tissue grows, and prolactin provokes the appearance of milk to feed the baby.
If unpleasant symptoms join intense discharge, you should consult a gynecologist:
- regular aching pain in the chest;
- bloody fluid from the nipples;
- the mammary glands increased unevenly, pronounced edema appeared;
- there are bumps or depressions.
Many symptoms will help to remove comfortable underwear that does not constrain the chest, there is no feeling of pressure.
Colostrum before menstruation
A few drops of a transparent liquid is a normal physiological phenomenon. Allocations of this nature should not frighten a woman, it is worse if colostrum continues to expire for a long time without pregnancy. This is a signal of hormonal imbalance, diseases.
What secretions do not need to be afraid
- Transparent, rarely occurring. Liquid droplets that occasionally appear on the nipple are not dangerous. The reasons for their appearance may be a tight bra or premenstrual syndrome.
- Colostrum produced during pregnancy. This is an absolutely normal process that does not require treatment. Thus, the body prepares for feeding the baby.
- The appearance of a small amount of milk after the end of the feeding period. When a woman stops feeding her baby, she still has lactation for some time. Usually this condition lasts 2-3 months, and sometimes - six months or more. However, if a woman has long finished feeding, and galactorrhea does not stop, you need to see a doctor.
All other options should be cause for concern. These are signals of the presence of inflammatory, purulent, and sometimes malignant pathologies.
Causes of discharge from the nipples in men
Liquid or viscous discharge from the chest in men is formed with the same diseases as in women - traumatic lesions, uncomplicated and complicated mastitis, benign neoplasia, breast cancer, hypothalamic-pituitary dysfunctions, etc. The nature of the secret is determined by the disease that provoked its occurrence. With particular caution should be perceived discharge, which appeared for no reason against the background of gynecomastia and is combined with an asymmetric increase in one breast, axillary lymphadenopathy.
What to do
First of all, you need to know what exactly you should not do:
- Do not panic ahead of time and do not rush to diagnose a terrible disease in yourself. An accurate diagnosis can only be established by a doctor after an examination.
- Ignoring the symptoms and delaying a visit to the clinic is also not worth it. Yes, nipple discharge rarely indicates cancer. But they can be a manifestation of another, not so terrible, but still in need of treatment pathology.
If you are of reproductive age and you have a discharge from the nipples that has not disappeared with the start of the next menstrual cycle, you need to visit a doctor. If you are in menopause, and you have a discharge, this is definitely not normal, you need to urgently contact a mammologist.
In order to notice pathological changes in the breast in time, it is necessary to regularly conduct self-examination of the mammary glands. Do not forget to inspect the cups of the bra - they may leave traces of discharge.
In order to "catch" the onset of the disease in time, it is useful to conduct a periodic breast examination on your own. It's easy and doesn't take much time.
Inspection is carried out in the first half of the monthly cycle after the end of menstruation
- Having stripped to the waist, you need to stand in front of the mirror. Putting your hands down, carefully examine the chest - for redness, swelling, changes in the shape of the glands. Raise your hands behind your head, examine the chest in this position.
- Gently squeezing the nipples at the base, check for any discharge.
- Holding one hand behind the head, with gentle circular motions, examine each gland from the nipples to the armpits. Repeat the examination in the supine position.
Normally, no hardening or swelling should be felt in the chest. Any oddities should alert you - discharge, inverted nipples, bulges, changes in skin color.
It is required to examine the breast on your own every 3-4 months, this will allow you to notice any changes in a timely manner.
When detecting discharge from the mammary glands, be sure to immediately consult a doctor. There is no need to panic or be afraid. The vast majority of glandular discharges are not cancer. Among doctors, the term “carcinophobia” is even common, the fear of this disease is so strong among patients. Timely diagnosis and treatment will prevent the development of complications.
How is a diagnosis made with discharge from the nipples?
At the appointment, the specialist will collect an anamnesis of the disease. He will definitely ask the patient about how long the discharge has been bothering her, and whether they are accompanied by painful sensations in the chest. The volume of discharge, its color, the presence of other disturbing symptoms - including fever, visual impairment, etc. – all this is important for the diagnosis!
After collecting an anamnesis, the doctor proceeds to examine the patient's breast. To confirm or refute a preliminary diagnosis, it may also be necessary to conduct a number of instrumental and laboratory tests - mammography, blood tests, etc. The study of the ducts in our private clinic in Ryazan is carried out by ductography.
After the diagnosis is made, the mammologist selects a treatment regimen for the detected pathology. This can be antibiotic therapy in case of inflammation, antiviral treatment for patients with HPV, correction of the patient's hormonal background if it is disturbed in her body. If all these methods of treatment are ineffective, the doctor prescribes a surgical intervention.
Methodology of cytological research
The very procedure for taking smears of secretions from the mammary gland for cytology is nothing complicated. It is absolutely safe, painless and does not take much time. Hospitalization is not required for this - everything is done on an outpatient basis by the attending physician.
The algorithm for taking smears is as follows: the mammary glands are treated with an antiseptic solution sequentially from the nipple and to the peripheral region. Then the nipple is pressed to obtain a discharge and this material is applied to a sterile glass slide. The material is dried and sent to the laboratory for cytological examination.
Taking smears from the mammary gland is by far the best diagnostic technique for identifying pathological changes and diseases of the female breast. It has a lot of advantages, including speed, availability, harmlessness and high accuracy.
The procedure for taking smears of secretions (detachable) from the mammary glands does not require any special preparation from the woman. There are just a few rules that should be followed before the study:
- a week before the procedure, stop taking antibiotics and antifungal drugs;
- if the patient is taking hormonal drugs, this must be reported to the doctor;
- do not use deodorants or other aromatic products directly on the day of taking smears;
- before going to the doctor, thoroughly wash the mammary glands.
Interpretation of the cytological conclusion
Cytological conclusion about hyperplasia of the epithelium of the mammary gland (with presumptive or confident cyst, fibrocystic disease, or fibroadenoma) allows the clinician to plan treatment tactics.
With a confident conclusion about the malignant process, established by qualified specialists, a cytological diagnosis can serve as the basis for planning treatment. If necessary, the cytological diagnosis is supplemented by molecular studies.
If the cytologist cannot judge the pathological process due to insufficient amount of material, necrotic changes and For other reasons, it is desirable to repeat FAB with a more careful selection of the site for puncture, several passes with the needle in different directions.
With a cytological diagnosis of dysplasia, severe dysplasia, hyperplasia with atypia (or hyperplasia with atypia of individual cells), as well as with a presumptive cytological conclusion about a malignant process with a small amount of cellular material, it is possible to clarify the diagnosis with using repeated puncture with a fine needle or histological examination (trephine biopsy or sectoral resection with urgent histological research).
Treatment is carried out depending on the identified pathologies. Patients are prescribed:
- Preparations that normalize the production of hormones - reduce the production of prolactin and correct the formation of other hormonal substances.
- Antibiotics used in purulent processes.
- Anti-inflammatory and analgesic drugs that relieve discomfort.
If a tumor is found, it is removed. After the operation, the patient requires observation by a mammologist, which allows timely detection of recurrences of the tumor process.
All patients who have a periodic appearance of discharge from the chest should regularly undergo an ultrasound of the mammary glands and be tested for hormones. This will allow you to track the course of diseases and detect malignant neoplasms in time.
Medical tactics depend on the disease that caused the expiration of the secret of the mammary glands from the nipples, the age of the patient, the presence of pregnancy, and extragenital pathology also matter. For treatment, etiotropic and pathogenetic agents are selected. Complex therapy includes medications, physiotherapy methods. The following groups of drugs are most often prescribed:
- Antibiotics. These medicines are used in all cases of bacterial lesions of the breast. At the beginning of treatment, the selection of drugs is carried out empirically, the therapy regimen is usually adjusted after receiving the results of bacteriological culture. Most often, antibiotics from the group of beta-lactams, macrolides are used.
- NSAIDs. Anti-inflammatory drugs are indicated as pathogenetic therapy for mastitis, the consequences of chest injuries. The drugs improve general well-being, eliminate pain, well stop local signs of inflammation. NSAIDs are prescribed with caution in the presence of concomitant diseases of the gastrointestinal tract (ulcers, gastritis).
- Hormonal agents. For the treatment of various forms of mastopathy, antiestrogens are recommended - medicines that reduce the effect of sex hormones on breast tissue and prevent the growth of fibrous tissue. Oral contraceptives are prescribed to reduce the concentration of estrogen, normalize hormonal levels.
- Cytostatics. Chemotherapy drugs are used for malignant neoplasms of the mammary glands as an independent method or as a preparation for surgical treatment. Therapy regimens are selected individually, taking into account the results of cytological and molecular diagnostics. Treatment may be supplemented with radiation therapy.
In complicated forms of mastitis, opening and drainage are indicated. If the discharge is caused by benign or malignant tumors, surgery is recommended. Based on the data on the stage of the disease and the histological characteristics of the tumor, different types are prescribed. surgical operations: excision of a fibrous node or cyst, sectoral resection of the mammary gland, lumpectomy. Diffuse changes in the breast, the presence of a malignant neoplasm are indications for radical mastectomy followed by mammoplasty.