Why does nipple secretion occur?

This is the 4305th article of Da Yi Xiao Hu

Nipple secretion often occurs in women of childbearing age. When they go to the hospital for treatment, they often have red and large amounts of fluid. Women often get nervous when they find that their nipples are secreting fluid, but there is no need to be nervous. A small amount of nipple secretion is a normal physiological phenomenon. Only when the secretion increases or bloody fluid appears should we pay more attention. The reason for concern is whether it is breast cancer. Today, let's learn about the phenomenon of nipple secretion.

1. What are the reasons for nipple secretion?

Nipple secretions can be divided into physiological and pathological types. Physiological secretions refer to a small amount of secretions from one or both breasts during pregnancy, lactation, or after weaning. The color is mostly white milky or colorless and transparent. Usually, this nipple phenomenon disappears with the end of pregnancy and lactation, so pregnant women do not need to worry too much. In addition, it is normal for women to have a small amount of fluid when their nipples are squeezed during perimenopause, and for women to have nipple secretions caused by drugs.

Pathological secretion of fluid refers to the secretion of fluid by the mammary duct under non-physiological conditions, which mainly manifests as bloody fluid. The main causes include inflammation, intraductal papilloma, intraductal papillary carcinoma, invasive ductal carcinoma, etc. Therefore, the secretion of bloody fluid requires special attention.

2. Qualitative analysis and localization of nipple secretion fluid

Milky or transparent secretions from multiple duct openings on both nipples are often caused by endocrine system diseases, medication, or mammary duct dilatation, and generally do not require special treatment. Bloody secretions are generally pathological secretions. Patients often seek medical attention due to single-hole secretions from one nipple, and often require further examination. Clinically, the qualitative and localized examination measures for nipple secretions are as follows:

1. Secretory fluid smear cytology examination

Most of the lesions that cause fluid secretion are located in the mammary ducts or originate from the ducts. The diseased cells fall off and flow out with the secreted fluid. Therefore, in theory, smear cytology of nipple fluid secretion is the simplest and most feasible diagnostic method. However, in clinical practice, the positive rate of nipple fluid smears for shed cancer cells is not ideal. Most tumors that cause nipple fluid secretion are intraductal papillary tumors or ductal carcinoma in situ. The probability of nipple fluid secretion in invasive breast cancer is not high.

2. Breast Ultrasound

Ultrasound examination is often the first choice for diagnosing breast diseases, but patients often do not have obvious abnormalities during ultrasound examination. Some ultrasound examinations can show dilation of breast ducts or small nodules in the ducts, but it cannot be determined that the nodules are definitely the cause of nipple fluid secretion. It is often necessary to combine breast ductography or ductoscopy to determine the location and extent of the lesion.

3. Mammary ductography

Ductography is currently the most valuable clinical method for locating nipple fluid secretion lesions. X-ray ductography can not only show the morphology of the fluid secretion duct, but also help determine the location of the lesion in the breast, the range of the entire lesion duct, and can also help determine whether the lesion is benign or malignant.

4. Ductoscopy

Ductoscopy can directly observe the situation in the breast ducts, providing evidence for patients and doctors to decide on surgical methods. However, the distal breast duct branches are thin and the ductoscope cannot enter. Ductoscopy is of great value in the diagnosis of intraductal papilloma.

5. Blood test

A blood test is done to check whether the progesterone and prolactin levels in the female hormones are elevated. If elevated, a head pituitary MRI is also needed to rule out a pituitary tumor in the brain, and then symptomatic treatment is given.

3. Treatment and prevention of nipple fluid secretion

1. Diet therapy

The onset of nipple secretion is generally believed to be related to high estrogen levels in the body, so in daily life you should avoid estrogen-rich foods and drugs, such as birth control pills, and supplement with high-quality protein and vitamins.

2. Drug treatment

If it is caused by mastitis, anti-inflammatory treatment can be given first, and abscess incision and drainage can be performed after the abscess is formed. For nipple secretion caused by endocrine factors, such as increased prolactin, bromocriptine can be used to treat the primary disease.

3. Surgical treatment

Most cases of nipple secretion do not require surgical treatment. Nowadays, with the popularization of ductoscopy technology, many patients with nipple secretion have achieved "minimally invasive cure".

4. Breast self-examination

It is recommended that women perform regular breast self-examinations and squeeze their nipples. If there is secretion or red or brown liquid on the bra, take photos and record them in time, or seek medical attention early if a lump is found.

The most serious indications of nipple secretion are pituitary tumors and breast cancer. Therefore, female friends, especially non-lactating women, should pay more attention to bloody nipple secretion, and ensure early detection, early diagnosis, and early treatment. Do not be ashamed of your illness and avoid seeking medical treatment.

Author: General Surgery, Shanghai Tenth People's Hospital

Chu Juhang Qian Mingping