Nipple discharge is a presenting complaint of between 3-7.4% of women seeking medical care for breast problems. Differentiating between physiologic and pathologic nipple discharge is important for management.

•           Physiologic nipple discharge is from bilateral breast, from multiple duds, non- spontaneous, multi- coloured (milky, grey, green, brown, yellow) with thick sticky consistency.

•           Pathological nipple discharge is usually from unilateral breast, from single duct, spontaneous colour is bloody, serous or clear and consistency is watery and copious.

Causes of pathologic nipple discharge papilloma, papillomatosis, ductal carcinoma in situ, invasive ductal carcinoma.

Management

•           Check for character of discharge and any lump in the breast.

•           Galactorrhoea in non- lactating or without pregnancy then get serum prolactin and thyroid profile

•           If discharge is from multiple ducts, bilateral, expressible then reassure the patient and mammogram if over 40 years of age.

•           If profuse multiple duct in post - menopausal lady consider Hadfields surgery.

•           If discharge is multi-coloured, from single duct, unilateral, spontaneous, serous, bloody then get mammogram and ultrasound.

•           If the discharge is from singe duct, profuse, spontaneous, blood stain, RBC on cytology then duct excision.