Pathologic Nipple Discharge

Rodrigo Arrangoiz MS, MD, FACS, FSSO
  • Pathologic nipple discharge:
    • Is characteristically spontaneous, unilateral, uni-ductal or bloody
  • Physiologic discharge:
    • Is nonspontaneous, bilateral, and milky
  • The most common causes for pathologic nipple discharge are:
    • Benign:
      • Intraductal papillomas
      • Duct ectasia
  • In a patient with a pathologic nipple discharge:
    • And the presence of abnormal clinical findings on imaging or physical exam:
      • Is associated with increased risk of malignancy:
        • 38% vs. 2%
  • Contemporary workup for nipple discharge includes:
    • Mammography
    • Evaluation of the retroareolar region with ultrasound
      • Patients with normal findings on mammography, ultrasound, and physical exam:
        • Can be further evaluated with breast MRI, as it is highly sensitive and specific for cancer
  • A patient with abnormalities in the physical exam and in imaging (ultrasound or mammography:
    • Would need surgical intervention even with a negative breast MRI
  • Surgical management of nipple discharge includes:
    • Excision of a single duct or central duct apparatus:
      • Depending on the number of ducts involved
  • References
  • Li GZ, Wong SM, Lester S, Nakhlis F. Evaluating the risk of underlying malignancy in patients with pathologic nipple discharge. Breast J. 2018;24(4):624-627.
  • de Paula IB, Campos AM. Breast imaging in patients with nipple discharge. Radiol. Bras. 2017;50(6):383-388.
  • Yilmaz R, Bender O, Celik Yabul F, Dursun M, Tunaci M, Acunas G. Diagnosis of nipple discharge: value of magnetic resonance imaging and ultrasonography in comparison with ductoscopy. Balkan Med J. 2017;34(2):119-126.
#Arrangoiz #BreastSurgeon #CancerSurgeon #SurgicalOncologist #Miami #Mexico #MountSinaiMedicalCenter #MSMC #BloodyNippleDischarge #NippleDischarge #BreastCancer

Published by Rodrigo Arrangoiz MS, MD, FACS, FSSO

My name is Rodrigo Arrangoiz I am a breast surgeon/ thyroid surgeon / parathyroid surgeon / head and neck surgeon / surgical oncologist that works at Center for Advanced Surgical Oncology in Miami, Florida. I was trained as a surgeon at Michigan State University from (2005 to 2010) where I was a chief resident in 2010. My surgical oncology and head and neck training was performed at the Fox Chase Cancer Center in Philadelphia from 2010 to 2012. At the same time I underwent a masters in science (Clinical research for health professionals) at the University of Drexel. Through the International Federation of Head and Neck Societies / Memorial Sloan Kettering Cancer Center I performed a two year head and neck surgery and oncology / endocrine fellowship that ended in 2016. Mi nombre es Rodrigo Arrangoiz, soy cirujano oncólogo / cirujano de tumores de cabeza y cuello / cirujano endocrino que trabaja Center for Advanced Surgical Oncology en Miami, Florida. Fui entrenado como cirujano en Michigan State University (2005 a 2010 ) donde fui jefe de residentes en 2010. Mi formación en oncología quirúrgica y e n tumores de cabeza y cuello se realizó en el Fox Chase Cancer Center en Filadelfia de 2010 a 2012. Al mismo tiempo, me sometí a una maestría en ciencias (investigación clínica para profesionales de la salud) en la Universidad de Drexel. A través de la Federación Internacional de Sociedades de Cabeza y Cuello / Memorial Sloan Kettering Cancer Center realicé una sub especialidad en cirugía de cabeza y cuello / cirugia endocrina de dos años que terminó en 2016.

Leave a Reply

Fill in your details below or click an icon to log in:

Gravatar
WordPress.com Logo

You are commenting using your WordPress.com account. ( Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. ( Log Out /  Change )

Cancel

Connecting to %s