- small, benign (noncancerous) tumors
- hypothyroidism (underactive thyroid)
- ectasia (widening of the milk ducts)
- pituitary gland tumor
- Paget’s disease of the breast
- prolactin level blood test
- thyroid hormone test
- CT scan
- MRI scan
Nipple problems can occur in men or women, and are caused by illnesses starting in your body or irritants in your environment. This article addresses nipple problems in both sexes, but not in women who are breastfeeding or who have just had a baby.
Many nipple problems are not related to breast cancer, but they could indicate a serious underlying condition. Always see a doctor if you have nipple discharge. Nipple problems, including those involving the milk ducts, can develop in men as well as women.
Newborn babies sometimes have discharge from their nipples because they’ve been absorbing the hormones of their mother, whose body is preparing her for breastfeeding. Nipple discharge in babies is sometimes called “witch’s milk.” It’s not considered dangerous and should go away promptly.
Nipple discharge is more common in older women if they’ve been pregnant, even many years ago.
Your nipples can become irritated, sore, or even cracked due to friction. Running and sexual activity are sometimes causes of temporary nipple problems due to vigorous rubbing.
There are also medicines prescribed for unrelated conditions that can cause breast swelling and nipple discharge. For example, according to its manufacturer, Janssen, the prescription drug Motilium, which is used to treat nausea, can increase prolactin levels. Prolactin is a hormone that’s produced by the pituitary gland in order to stimulate breast development and milk production in women. Certain birth control pills can also cause nipple problems, including discharge.
A severe blow to your breast or unusual pressure on the chest can also cause nipple discharge.
You will know right away if you have a nipple problem. You might see discharge, such as pus or a white, watery fluid. You may also feel pain, itchiness, or swelling in your nipples. See your doctor right away if you have any discharge at all or discomfort that lasts for more than a few days.
You may also notice changes in the shape of your nipple(s) or in the areola (the skin around your nipple), such as puckering or dimpling of the skin. Always discuss changes like this with your doctor.
Monthly discomfort that lasts just a few days could be related to hormone fluctuations during your menstrual cycle. This doesn’t indicate a nipple problem, but if it bothers you, don’t hesitate to tell your doctor.
Your doctor will examine your nipple and areola. He or she will ask you about medicines you are taking, any changes in your diet, whether you might be pregnant, and any recent exercise or activity that could have irritated your nipples.
If your problem involves discharge, your doctor may perform a test to find out how many of the ducts that bring fluid to your nipples are involved. This is called a ductography. During a ductography, dye is injected into the ducts in your breasts and an X-ray is taken to monitor the ducts’ function.
Your doctor may want you to have a mammogram. A mammogram is an imaging test that records an image of the tissues inside your breast. This exam can reveal if there is a growth inside your breast causing the problem.
If your doctor thinks you may have Paget’s disease—a rare breast cancer—he or she may order a skin biopsy. This will involve removing a tiny piece of skin from your breast for examination.
Other tests you might receive include:
The treatment for your nipple problem will depend on its cause.
Infections of the nipple will be treated with the appropriate medicine. For example, a bacterial infection will require antibiotics. If you have a fungal infection, such as candidiasas, your doctor will prescribe an antifungal. These medicines may be taken by mouth or applied to your skin.
Small, benign tumor
A noncancerous tumor doesn’t need to be removed, but your doctor may schedule you for regular check-ups to monitor its growth.
Hypothyroidism is when your body doesn’t produce enough thyroid hormones and can upset the normal balance of chemical reactions in the body. Replacing the missing hormones with a prescription medicine can treat hypothyroidism.
Most ectasia, swollen milk ducts, goes away on its own. If you continue to be bothered by it, you should ask your doctor about surgery to remove the swollen milk ducts. If ectasia causes a bacterial infection in your nipples, your doctor can prescribe an antibiotic.
Also known as prolactinoma, a pituitary tumor is usually benign and might not require treatment at all. Because of its location in your head, these tumors can press on the nerves that lead to your eyes, causing vision problems if they grow too large. In that case, surgery is required to remove them.
Pituitary tumors can also be treated with two medicines, bromocriptine and cabergoline, which reduce the amount of prolactin in your system. If the tumor does not respond to medication or continues to grow, radiation treatments may be necessary.
Paget’s disease of the breast
The treatment for this cancer depends on whether tumors are found elsewhere in the breast besides the nipple. If no other tumors are found, treatment includes surgery to remove the nipple and areola, followed by a series of radiation treatments on the whole breast. If other tumors are found, you may need a mastectomy to remove the entire breast.
Some nipple problems can be prevented. If possible, avoid medicines that are associated with nipple problems, or ask for a change in medication if you’re already taking one. If you have hypothyroidism, stay on your prescription medicines, even if you feel better.
You can prevent nipple problems when you exercise by wearing properly fitting clothes. Women who run or ride horses often should wear a well-fitting sports bra. Men who do the same should consider wearing a snug-fitting undershirt.