Bleeding or Discharge from the Nipple

What different types of nipple discharge mean

Many women can express a few drops of fluid from the nipples if they squeeze, and this is normal. What matters is the color, whether it comes from one or both breasts, whether it comes from one or several duct openings, and whether it happens on its own.

Causes of bleeding or discharge from the nipple

Intraductal papilloma

A small, benign wart-like growth inside a milk duct near the nipple. It is the most common cause of bloody or clear discharge from one duct, usually in women aged 35 to 55. There may be a small lump behind the nipple. See papilloma.

Duct ectasia

Ducts under the nipple widen and fill with thick fluid as women approach menopause. The discharge is often sticky and green, black or gray, from several ducts, sometimes with tenderness or a slit-like inward nipple.

Fibrocystic changes

Lumpy, tender breasts that change with the menstrual cycle can produce yellow, green or brown discharge from several ducts. See fibrocystic breast disease.

Milky discharge (galactorrhea)

Milk production outside pregnancy and breastfeeding, usually from both breasts. Causes include:

• high prolactin from a benign pituitary tumor (prolactinoma)
• medicines: some antipsychotics, metoclopramide, some antidepressants, opioids, hormonal contraceptives
• an underactive thyroid
• frequent nipple stimulation
• for several months to two years after breastfeeding stops

Read more on galactorrhea.

Infection

Mastitis or a breast abscess causes pus-like discharge with a red, hot, swollen, painful area of breast and often fever. It is most common during breastfeeding, but it also occurs in smokers outside breastfeeding (periductal mastitis).

Bleeding from the nipple skin

Blood may come from the skin rather than from a duct:

• cracked or blistered nipples from breastfeeding, usually from a poor latch
• friction from running (jogger's nipple) or tight clothing
• eczema of the nipple
• Paget's disease of the nipple: a persistent scaly, red, crusting, sometimes bleeding rash on one nipple, linked to an underlying breast cancer

Pregnancy

Some women have blood-stained discharge in the second or third trimester ("rusty pipe" discharge) from increased blood flow to growing ducts. It usually settles, but should still be mentioned to your provider.

Breast cancer

Breast cancer causes nipple discharge in only a small percentage of cases. The risk is higher when discharge is bloody or clear, from one duct, spontaneous, occurs after age 50, comes with a lump, or happens in a man.

How doctors check nipple discharge

1. History: color, one or both sides, spontaneous or not, pregnancy, periods, medicines.
2. Breast exam: looking for a lump and pressing around the nipple to find which duct the fluid comes from.
3. Imaging: a diagnostic mammogram (age 30 and over) and ultrasound of the area behind the nipple. MRI is used if these are normal but the discharge is suspicious.
4. Blood tests for milky discharge: prolactin, thyroid function and a pregnancy test.
5. Biopsy of any abnormal area found on imaging.
6. Duct excision: surgery to remove the affected duct, used to diagnose and cure persistent single-duct discharge.

Treatment

• No treatment for physiologic discharge. Avoid squeezing the nipples, which keeps it going.
• Papilloma: removal of the duct, usually as a day procedure.
• Duct ectasia: warm compresses and supportive bras; antibiotics if infected; duct excision if persistent.
• Galactorrhea: stopping or switching a causative medicine, treating thyroid problems, or medicine (dopamine agonists) for a prolactinoma.
• Mastitis: keep breastfeeding or pumping, antibiotics if bacterial, and drainage of an abscess.
• Cracked nipples: latch correction with a lactation consultant, and nipple balm.
• Cancer: treatment depends on type and stage.

Frequently asked questions

Why is my nipple bleeding?

The most common reasons are cracked skin from breastfeeding or friction, and an intraductal papilloma, a benign growth in a milk duct. Duct ectasia and infection can also cause blood-stained discharge. Because bloody discharge occasionally signals breast cancer, see a doctor unless the cause is clearly a cracked nipple.

Is bloody nipple discharge always cancer?

No. Most bloody discharge is caused by intraductal papillomas or other benign conditions. However, it is the type of discharge most likely to be linked to cancer, so it should always be checked with an exam, mammogram and ultrasound.

What does discharge from one nipple mean?

Discharge from only one breast, especially from a single duct and without squeezing, is more likely to have a specific cause such as a papilloma. It needs imaging. Discharge from both breasts, from several ducts and only when squeezed is usually normal.

Can men have nipple discharge?

Yes, but it is uncommon and always needs assessment. In men, nipple discharge, particularly if bloody, is more often linked to breast cancer than in women. Hormone problems and some medicines can also cause it.

Is it normal to have discharge when squeezing my nipples?

Often yes. Many women can express a small amount of milky, green or yellow fluid from several ducts in both breasts. Stop squeezing, since stimulation keeps it going, and see a doctor if it becomes spontaneous, bloody, one-sided or persistent.