Nipple Discharge

Question 1

What needs to be considered with breast discharge?

Answer 1

1. Duct Ectasia
2. Duct papilloma
3. Could it be cancer?

Question 2

What is the path of duct ectasia?

Answer 2

1. Dilation of large breast ducts

2. Ducts can become blocked and lead to fluid build up

Question 3

What are the key features of duct ectasia?

Answer 3

1. Perimenopausal women (during), irregular periods
2. Nipple changes: slit like retraction
3. Tender lump around the areola +/- green discharge

Question 4

What are Ix for duct ectasia?

Answer 4

often found coincidentally when doing biopsy

Question 5

What is the conservative management for duct ectasia?

Answer 5

• Warm compress

* Abx: if redness, tenderness, fever

Question 6

What is the surgical treatment for duct ectasia?

Answer 6

If troublesome

1. Microdochectomy
2. Total duct excision

Question 7

What are papillomas?

Answer 7

benign wart like tumors

Question 8

What can papillomas be made of?

Answer 8

1. gland
2. fibrous
3. blood vessels

Question 9

What is the patho of duct papilloma?

Answer 9

1. Papillomas (benign wart like tumors) grow in ducts
2. Can be made of gland, fibrous and blood vessels
3. Occludes duct a bit

Question 10

What are the features of duct papilloma?

Answer 10

1. Clear or blood-stained discharge from a single duct

2. Rarely present as a lump

Question 11

What Ix are done in a duct papilloma?

Answer 11

1. Imaging – MMG / USS
2. Galactogram – dye injected into nipple duct + X-ray (see if occlusion as dye won’t get through)
3. Biopsy

Question 12

What does management of duct papilloma depend on?

Answer 12

• Size
• Number of papilloma’s
• Associated sinister findings (FLAWS)

Question 13

What is the surgical management of a duct papilloma?

Answer 13

Microdochectomy