Breast discharge

Breast discharge

·        Causes:

o  Causes of galactorrhoea:

§  Physiological

§  Drug related (eg dopamine)

§  Bronchogenic cancer

§  Prolactinoma 

o  Duct ectasia (periductal mastitis) – most common cause in pre-menopausal women. Discharge may be serous, greenish or bloody 

o  Carcinoma: usually associated with a palpable mass – cause in 10% over age 55. Cancer unlikely if discharge is coming from both nipples and/or multiple ducts. Cytologic examination has 50% sensitivity

·        Management:

o  History and exam

o  Get mammogram, re-examine in 3 and 12 months, and repeat mammogram in 12 months

o  Sample to discharge to lab

o  Check serum PRL, especially if a pre-menopausal woman has irregular periods

·        Pregnancy and discharge:

o  Epithelial hyperplasia may ® blood-stained discharge (usually normal)

o  Galactocoele: a milk filled cyst due to plugged duct

·        Galactorrhoea:

o  Physiological: menarche/menopause

o  Secondary to dopamine: chlorpromazine, haloperidol, metoclopramide, methyldopa

o  Prolactinoma: bronchogenic cancer or pituitary tumour