This article was medically reviewed on 28/10/2020 by Dr Jeff Livingston
If you’re a woman, you spend a great deal of time checking your breasts for lumps. If you don’t, it is a habit you should develop from a reasonably young age. In fact, the earlier you start the more familiar you will become with the feel of your breast. If you are intimate with how your healthy breast feels, then you are so much more likely to pick up any early changes or signs of trouble.
What a lot of women don’t know, is that their nipples can also act as an early warning system for a host of breast related problems. Here are five potential issues that can affect your breasts and how these will affect your nipples. Many of these conditions, like Paget’s disease of the breast, can also affect men, but are far more rare.
Paget’s Disease
Not to be confused with Paget’s disease of the bone, Paget’s disease of the breast is a rare form of breast cancer. It starts on the nipple and extends to the dark circle of skin, the areola, around the nipple. The disease is most likely to affect women over the age of fifty.
Women with Paget’s disease often have underlying ductal breast cancer or in rare instances, invasive breast cancer. Paget’s very rarely confines itself to only the nipple, so early detection is crucial and your nipples will provide you with warning signs if you know what to look for.
Symptoms of Paget’s disease of the breast
Signs and symptoms usually occur in only one breast and the disease typically starts in the nipple and may spread to the areola and other areas of the breast. It is easy to mistake the signs and symptoms of Paget’s for skin irritation (dermatitis) or another noncancerous (benign) skin condition. Signs and symptoms of Paget’s disease that are visible on your nipple include:
- Flaky or scaly skin on your nipple
- Crusty, oozing or hardened skin resembling eczema on the nipple, areola or both
- Itching
- Redness
- A tingling or burning sensation
- Straw-colored or bloody nipple discharge
- A flattened or turned-in (inverted) nipple
If you notice one or more of these symptoms, consult your doctor. They are more often than not, related to other conditions, but a doctor will be able to properly assess them. Early detection is critical with cancers.
Ectasia
First the good news, Ectasia isn’t cancerous. Usually affecting women who are entering menopause or older, ectasia is the natural widening or dilation of the milk duct in aging women. The mammary ducts are located under the nipple and in some cases, this dilation can lead to blockages of the ducts.
Fluid build up can leak into adjoining tissue and cause infection, chronic inflammation or an abscess. Infections from this process are called periductal mastitis and can result in scar tissue forming. This process will draw your nipple inwards and can produce a thick, sticky nipple discharge. Your breast will also feel tender.
Treatment depends on the severity of your symptoms. A warm compress will offer relief and antibiotics will address the infection. For recurrent or serious cases surgery may be required to remove the duct.
Intraductal Papilloma
An intraductal papilloma is a small, usually harmless wart-like growth (tumor) that bumps out into the breast ducts near the nipple. Although the condition is mostly benign, a study in 2017 found approximately 17% of these growths to be atypical or cancerous. Papilloma’s cause a bloody or sticky discharge from the nipple.
Any slight bump or bruise near the nipple can also cause the papilloma to bleed. If the discharge becomes annoying, the duct can be surgically removed. This can often be done without changing the look of the breast.
Single papilloma most often affect women nearing menopause. Multiple intraductal papilloma’s are however more common in younger women and often occur in both breasts. Multiple intraductal papilloma’s are more likely to be linked to a lump than with nipple discharge. Any papilloma linked to a lump is surgically removed.
Papilloma’s are most likely to occur near the nipple, but can occur in the deeper tissue of the breast, more likely with multiple intraductal papilloma’s. This is also an indicator of an increased risk of breast cancer and you should discuss this with your doctor. The condition can also rarely occur in men. It can be painful and is occasionally accompanied by an itching sensation in the nipple.
Lactational Mastitis
Your nipples can produce discharge for a number of reasons. If the discharge is as a result of your breasts and nipples being squeezed or manipulated, then this probably isn’t reason for concern. When should you be worried about discharge?
Women who are breastfeeding may experience a lump under the areola in conjunction with discharge. This is not necessarily of concern as infections called lactational mastitis are quite common in breast feeding women. A pus filled abscess forms and treatment can be as simple as changing your breast feeding technique or in some instances, may require antibiotics.
When antibiotics are needed, those effective against Staphylococcus aureus (e.g., dicloxacillin, cephalexin) are preferred. This line of treatment is often accompanied by incising and draining pus from the affected ducts to reduce swelling and risk of further infection. Seek urgent medical attention if you suffer from this condition as delaying treatment can lead to the formation of an abscess which is harder to treat and leads to the formation of scar tissue in your breast.
If you are not breast feeding, then any discharge accompanied by a lump is cause for concern and you should seek immediate medical advice.
Galactorrhea
This mouthful sounds like an STD but is actually the term doctors use to refer to a milky discharge from the nipples in women that aren’t breastfeeding. This can occur for a number of reasons;
- An increase in the hormone prolactin, which produces milk.
- Galactorrhea may occur if you take sedatives or marijuana.
- High doses of estrogen can cause galactorrhea. Women who have this often have irregular menstrual periods or their periods have stopped.
- Galactorrhea can also, in rare instances, be caused by a pituitary gland tumor. Your doctor will schedule an MRI if they suspect your pituitary gland may be involved.
How doctors assess nipple discharge
Nipple discharge can vary in consistency and color. It’s important to find out if the discharge is coming from one or many ducts. If multiple ducts are involved that is almost always a positive sign, as in most of these cases the cause is benign (not harmful cancers).
If a single duct is involved more tests may be required. Your doctor may schedule a mammography (breast scan) and may take a sample of the discharge for further lab analysis to confirm a diagnosis. If your mammography doesn’t display any abnormalities, then surgery usually isn’t required.
