PDF] Breast Pain , Nipple Pain and Nipple Discharge – An Overview

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Nipple discharge is the most worrying of the symptoms among these three, in terms of detecting the malignancy, especially, if the discharge is haemorrhagic. Breast pain (Mastalgia) is the 2nd most common presenting symptom at Breast Clinics all across the world [1]. Nipple Discharge and pain are the next in order. Patients are usually worried about a potential underlying diagnosis of cancer, however, the incidence of malignancy is actually fairly low among the patients presenting with these symptoms. Aetiology of mastalgia is poorly understood, making appropriate treatment methods more difficult to identify. Reassurance, breast support brassiere and topical non-steroidal creams are commonly used in the management of breast pain. Nipple pain, on the other hand, occurs in a particular set of patients – breastfeeding women – and usually has a more clear-cut underlying diagnosis, i.e. infection, cracked nipple, vasospasm or poor breastfeeding technique. The underlying cause should be identified and treated in a timely manner while continuing with breastfeeding, if at all possible. Nipple discharge is the most worrying of the symptoms among these three, in terms of detecting the malignancy, especially, if the discharge is haemorrhagic. Investigations and treatment of nipple discharge largely differs, depending upon whether or not intraductal pathology is identified. Other systemic causes should be considered, especially in patients with bilateral nipple discharge. Novel diagnostic methods are also on the rise and can help practitioners investigate patients with nipple pain and discharge in a less invasive manner, with Magnetic Resonance Imaging, or special biomarkers. All in all, mastalgia, nipple pain and nipple discharge are frequent complaints and each needs to be investigated thoroughly in order to tailor the treatment best suited to the individual patient.