Nipple problems

Nipple tenderness may be caused by dry skin in the areolar region (the darker area surrounding the nipple) of the breast. Women who are breastfeeding can have irritated nipples from too much moisture or if the baby doesn't latch on properly while nursing. Injury to or friction over the nipple area can cause tenderness, as can other skin problems such as bacterial or fungal infections.

A milky-appearing nipple discharge can be normal during pregnancy, shortly after delivery, or when breastfeeding. Birth control pills and chlorpromazine-type drugs can also cause a nipple discharge.

Abnormal nipple discharge can be caused by hormone imbalances, growths in the breast tissue that are not cancer, or, rarely, by breast cancer. Milky discharge can occasionally be caused by pituitary tumors, severe hypothyroidism, or recent severe injury to the chest wall.

• Breast tenderness
• Clear, milky, bloody, or discolored (green or brown) discharge
• Increased surface temperature of portion of the breast
• Nipple discharge
• Pain occurs with or without pressure on the breast
• Redness, tenderness and/or cracking of the skin surface of the nipple
• Swelling of some portion of the breast (breast lump)

The health care provider will take your medical history and perform a physical examination.

• Blood tests for prolactin level and thyroid function may be performed.
• Breast biopsy is performed if a mass or lump is found, or if the discharge is occurring on its own, without any pressure on the breast.
• Cytological evaluation (cell studies) of nipple discharge may be done in some cases.
• Mammography is usually performed if the cause is not obvious.

Treatment depends on the cause of the nipple problem. It may include:

• Medications
• Observation
• Surgery

In most cases nipple problems do not involve breast cancer and will go away with adequate treatment.

A nipple discharge may be a symptom of breast cancer or a pituitary tumor.

Call for an appointment with your health care provider if you have nipple problems.

Breastfeeding women should clean the breasts before and after feedings. If milk leaks between feedings, absorbant breast pads will help keep the nipples dry. Breast creams can help keep the nipple area soft and moisturized.

Valea FA, Katz VL. Breast Diseases: Diagnosis and Treatment of Benign and Malignant Disease. In: Katz VL, Lentz GM, Lobo RA, Gershenson DM, eds. Comprehensive Gynecology. 5th ed. Philadelphia, PA: Mosby Elsevier; 2007: chap 15.