Conditions Affecting the Nipple
A fissure is a longitudinal ulcer that tends to develop in breast-feeding women. If the nipple becomes irritated, a painful, raw area may form and become a site of infection. Daily washing with water, massage with breast milk or lanolin, and exposure to air are helpful. Breastfeeding can continue with a nipple shield, if nec-essary. If the fissure is severe or extremely painful, the woman is advised to stop breastfeeding; a breast pump can be used until the breastfeeding can be resumed. Persistent ulceration requires fur-ther diagnosis and therapy. Guidance with breastfeeding from a nurse or lactation consultant may be helpful because nipple irri-tation can result from improper positioning (ie, the infant has not grasped the areola fully).
Breast discharge in a woman who is not lactating may be related to many causes. Carcinoma, papilloma, pituitary adenoma, cys-tic breasts, and various medications can result in a discharge of fluid from the nipple. Oral contraceptives, pregnancy, hormone replacement therapy, chlorpromazine-type medications, and fre-quent breast stimulation may be contributing factors. In some athletic women, breast discharge may occur during running or aerobic exercises. Breast discharge should be evaluated by the health care provider, but it is not often a cause for alarm. One in three women have clear discharge on expression, which is usually normal. Causes for concern are green discharge, which usually in-dicates infection, and brown or red discharge, which is indicative of a disorder. Spontaneous discharge should always be evaluated because it is not normal unless a woman is lactating. The dis-charge is examined for fat globules to determine if it is breast milk. It is also tested for occult blood because malignancy must be considered.
At times, a bloody discharge may be produced when pressure is placed on one area at the edge of the areola. Although a bloody discharge can signal a malignancy, it usually results from a wart-like, benign epithelial tumor or papilloma growing in one of the large collecting ducts just at the edge of the areola or in an area of cystic disease. Bleeding occurs with any trauma, and the blood collects in the duct until it is pressed out at the nipple. Treatment includes excision of the duct with the papilloma. Such a lesion is usually benign, but it should be evaluated histologically after it is removed to rule out malignancy.