Spontaneous Nipple Discharge and Lump

Hello: I am scheduled for an ultrasound and possible mammogram for spontaneous unilateral discharge of breast (clear, watery). The ultrasound will be to look for dilated ducts.  Also noted is a very small lump outside areola which drs. are not suspicious of - feel it is prob. reg. breast tissue.

History: Last year, on OTHER breast, I had a ductogram and excisional biopsy, removal of ducts for Ductal Ectasia (more than 50% of my ducts were dilated).  Presented with episodes unilateral spontaneous bloody discharge followed by more regular episodes of spontaneous clear watery discharge. No lumps, papilloma, etc.  Surgery fixed problem.

Questions:  Can ultrasound alone diagnose ductal ectasia? Am I more likely to have ectasia again after having had it in other breast?  If ducts are NOT found to be dilated, what is next step?  Will the ultrasound give a definitive answer re: nature of lump?  If I do have ectasia again and cancer is not a worry, would surgery still be a possibility?

Thanks for your time.

[CCF-RN,MSN-rf]

Dear OhNelly2: Duct ectasia is a widening and hardening of the duct.  It usually affects women in their forties and fifties and can be characterized by thick green, black or clear nipple discharge.  The nipple and surrounding tissue may be red and tender.  Occassionally a hard lump can develop around the abnormal duct. Duct ectasia is usually diagnosed through physical examination and ultrasound, although additional testing may be recommended such as mammography, depending on the age of the woman. Ultrasound is very good at differentiating a solid vs. cystic lump but is not specifically diagnostic.  The data from ultrasound must be considered as
part of a total picture. Duct ectasia may or may not need treatment.  It may improve with heat application or antibiotics.  In some cases, the affected duct(s) can be surgically removed. If the ducts are not dilated, your doctor
will evaluate all the available data and determine the correct next step as it applies specifically to you.