Disease Description (Causes and Symptoms)
- Definition: A condition in which the mammary ducts (milk ducts) become blocked or dilated, causing discharge and inflammation; scar-like changes/inflammation around the ducts may also occur. It is common mainly around the time of menopause but can occur at any age.
- Pathophysiology: Accumulation of secretions within the ducts → duct dilation → inflammation of surrounding tissue (=periductal inflammation) → nipple discharge, nipple inversion, a localized mass, and calcification. If bacterial infection occurs, an abscess may form.
- Main symptoms: Breast pain, a breast lump (palpable like a mass), redness and swelling around the nipple, nipple discharge (which may vary, including green, brown, or bloody discharge), and nipple inversion (turning inward). Systemic symptoms (fever and chills) may occur when inflammatory complications are present.
Treatment Methods
- Conservative treatment (when symptoms are mild or absent)
- Observation: If there are no symptoms or symptoms are mild, observation without specific treatment.
- Symptomatic treatment: Relieve pain with warm compresses, a supportive bra, and nonsteroidal anti-inflammatory drugs (NSAIDs).
- Medication therapy
- If inflammation or infection is suspected, an appropriate antibiotic (generally an antibiotic covering bacteria that cause skin and duct infections) is administered for a short period. The choice of medication depends on the clinical presentation and culture results.
- Procedures/Surgery
- If an abscess has formed: Needle aspiration or incision & drainage.
- In cases of persistent or bloody unilateral nipple discharge, recurrent infection, or diagnostic uncertainty (suspected cancer): Duct excision (central duct excision/microdochectomy or major duct excision) or biopsy (core needle biopsy/excisional biopsy).
- Precautions and self-care
- Recurrence is possible even after treatment. After drainage, follow wound infection care instructions and take prescribed medications as directed.
- Seek medical attention immediately if persistent or bloody nipple discharge, a mass that is increasing in size, skin discoloration, ulceration, severe pain, or fever occurs.
- Prognosis: Most cases improve with conservative treatment, but recurrence is possible, and some cases require surgical treatment. Differentiation from malignant disease (excluding breast cancer) is important.
Checklist Before an Outpatient Visit (Items to Prepare and Example Questions)
- Items to prepare/bring
- A list of current medications (including prescription medications, OTC medications, and supplements)
- Past medical history (breast surgery, breast disease, family history of breast cancer) and reproductive history (pregnancy and breastfeeding history)
- Recent breast examination results (mammography, breast ultrasound, biopsy results, etc.) or examination image files/reports
- Symptom records: time of onset, progression, severity of pain, discharge color·amount·whether unilateral/bilateral, and association with the menstrual cycle
- Examples of key information to explain to the medical staff during the visit
- When the discharge first appeared and what it looked like (color, odor, and whether it was bloody)
- Whether the discharge is from one breast or both breasts
- Any changes in warmth, fever, localized redness, or the lump
- Whether you recently experienced breast trauma or underwent breast surgery
Examples of General Questions to Ask the Doctor
- "Do I need additional imaging tests or a biopsy given my current condition?"
- "What is the expected duration of the prescribed antibiotic treatment, and what are its major side effects?"
- "How likely is this condition to be related to breast cancer? How should I be followed up?"
- "Are there any lifestyle precautions I should take to reduce the risk of recurrence after treatment?"
Examples of Condition-Specific Questions
- "If the nipple discharge continues, in what cases would you recommend duct excision (surgery)?"
- "I have had an abscess once. Is there any specific care or testing I should undergo to reduce the risk of recurrence (e.g., a recommendation to stop smoking)?"
(Note: If necessary, bringing the results of mammography, ultrasound, ductography (galactography), cytology, core needle biopsy, or other tests to the appointment can help with diagnosis and treatment planning.)