Nipple Discharge

1
Nipple Discharge
Bilateral Breast Exam
Age gt 35 Diagnostic Mammogram -- Unless negative
mammogram within past 6 months.
Bloody (lt5 associated with malignancy)
Non-Bloody

• R/O Mechanical Stimulation R/O Medication Cause
• Phenothiazine
• Reserpine
• Estrogen
• Opiates
• Check Prolactin Level Check TSH
  

Surgery Referral
Abnormal
Normal
Primary Care Physician to treat
Recheck 1 Month
If Unchanged or Resolved
Reassure

• Consider
• Single Duct (may be cancer) vs. Multiple Duct
  (not as worrisome)
• Bilateral (not as worrisome) vs. Unilateral (may
  be cancer)
• Ductograms do not R/O pathology and should not
  be ordered

2
Breast Pain Occurs in 70 of Premenopausal Females
Bilateral Breast Exam Assess currency with
screening mammograms (see Breast Cancer Screening
Guidelines)
Positive
Negative
Refer to Breast Lump Algorithm
Cyclic Pain
Non-Cyclic Pain
Mild to Moderate
Moderate to Severe

• Primary MD
  Assessment for
• Breast Disorder
• Chest Wall Disorder
• --Bone
• --Muscle
• --Joint
• Pleural Disease
• Cardiac Disease
• GI Disease

• Primary MD for possible hormone therapy
• Premenopausal--BCP
• Perimenopausal-- consider low dose BCP
• Postmenopausal--Decrease or stop Estrogen

• Non-Hormonal Therapy for 4-6 Months
• Reassurance
• Supportive Well-Fitting Bra
• NSAIDS
• Caffeine Decrease
• Oil of Primrose 1500-3000 mg daily (contains
  gamolenic acid)
• Vitamin E 800u daily

3
Infection/Mastitis (Non-Breastfeeding
Female) Inflammatory carcinoma should always
be considered.
Bilateral Breast Exam
Redness, Warmth, Swelling, Purulent Discharge,
Draining Wound
Warm Packs, NSAIDS, Antibiotics Cephalexin--500
mg po QID x 10 days Dicloxacillin--500 mg po QID
x 10 days E-mycin--333 mg. TID x 10 days if
allergic to penicillin
Recheck within 7-10 days or sooner if new or
increasing symptoms
Signs and Symptoms Alleviated
Signs and Symptoms Unchanged or Increased
Instruct Screening Mammogram per Age Guidelines
Surgery Referral
If breastfeeding, treat with antibiotics, as
above. Continue breastfeeding. If patient has
implants, consider longer course of antibiotics
or referral to Plastic Surgery.