Nipple Discharge – Watery – A Medical Anecdote – Learning Notes and Recommendations – 12oct14

Nipple Discharge – Watery – A Medical Anecdote – Learning Notes and Recommendations – 12oct14

October 11, 2012, Ms. CL came for her usual check-up with me for her watery nipple discharge.

Ms. CL is now 57 years old.  The first time she consulted me in 1998, she was 42 years old.  She has been having a breast check-up with me for the past 15 years for watery nipple discharge on her right breast.

A year before she consulted me in 1998, she was seeing an obstetrician-gynecologist who prescribed her bromocryptine mesylate (Parlodel) and danazole (Ladogal) with no response.  She also had serum prolactin test done which was normal.  She also had mammography which showed no abnormal findings.

When I saw her in 1998, I gave a diagnosis of watery nipple discharge related to fibrocystic breast changes.  She had no palpable breast mass.  I told her that there was no need to take any medicine, just monitoring and check-up.   I told her the discharge may not disappear.  What is more important is that there is no change in color to red and there is no development of a breast mass.

She has no family history of breast cancer.

For the past 15 years, she has been doing monthly breast self-examination.  She has been regularly coming to me at an interval of every 3 to 4 months for the past 15 years.  She does not want a mammography even when she reached the age of 50.   I respected her wish.  She does not want the pain associated with mammogram.  She trusts and prefers my gentle clinical breast examination over a mammogram.

The watery nipple discharge is still there, 16 years after it appeared.  There has not been any change in the color of the nipple discharge.  There is no development of a breast mass.

Learning Notes and Recommendations:

1.  In patients with watery nipple discharge without a dominant breast mass, my recommended primary clinical diagnosis is watery nipple discharge related to a fibrocystic breast condition.

2. Management will just be monitoring and check-up.   There is no need for drugs such as bromocryptine mesylate (Parlodel) and danazole (Ladogal) as they are not effective and are very expensive (more than P100 per tab with the patients spending thousands of pesos for the “trial” course).  There is no need to have a serum prolactin test done unless there are data in the history and physical examination findings that suggest a prolactin secreting tumor.  There is no need for a diagnostic imaging procedure like mammography and ultrasound unless there is uncertainty on whether a dominant mass is present or not.

3. Monitoring and check-up includes at least monthly breast self-examination on the part of the patient and regular breast specialist clinical breast examination at planned intervals.

4. Things to monitor include change in the color of the nipple discharge (red color is a red flag) and development of a dominant mass (another red flag).

 

 

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4 Responses to Nipple Discharge – Watery – A Medical Anecdote – Learning Notes and Recommendations – 12oct14

  1. nanee says:

    i hae the same problem with same color light brownish or dark yellow discharge shown up and little whitesh creamy in the midle of the watery discharge ,im 35y stopped breast feeding since 1 year and have family history,mother with breast cancer at the age 57y and father with prostate cancer ,i have no pain or any mass ,please i need your answer and opinion

  2. Marisa says:

    I too have the same symptom. I am 30 years old and have never conceieved. The leaks began 3 weeks ago in my left breast and occur after a hot shower or sometimes completely on their own with no provocation. I have done an ultrasound, blood test, and am waiting on a serum test report. I was told to go for a galactoram but I’m afraid to do so. My discharge is the same colour as in the picture (a watery yellow colour). My ultrasound came back clear. They didn’t see cysts or any abnormalities. I do, however, experience a gentle pain in the left breast, and the nipple of that breast seems different than the right. Should I be worried?

    • reyojoson says:

      If you are in the Philippines, you may want to see me. I have to do a physical examination on your breasts to give you an answer to your question. From what you presented, there is a high chance you don’t need the tests that you mentioned. Bring all the tests done already anyway. Dr. Rey

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