[Nipple discharge: personal experience with 2,818 cases]

After mastodynia, nipple discharge is the second most frequent condition that brings women to the attention of breast clinics. Seven types of nipple discharge exist: milky, multicolored, purulent, clear-watery, serous, pink or serosanguineous, brown or reddish-brown. From January 1982 to January 2003 we observed 2818 patients with nipple discharge (range: 16-83 years). Amongst these, 805 patients with nipple discharge were submitted to cytological examination of the secretions. One hundred and seventy-six had bilateral discharge, and 629 unilateral discharge. All patients with positive C3, C4 or C5 cytology and with unilateral discharge (227) were referred for surgical treatment. In 92 of these 227 cases (41%) the secretion was serous, in 59 cases (26%) bloody, in 45 cases (20%) purulent and in 31 cases (13%) multicolored. We performed duct galactophorectomy in 89 cases (39%), resection with reconstruction of the nipple-areola complex in 48 cases (21%), microdochectomy in 42 cases (18.5%), segmentectomy or quadrantectomy in 41 cases (18%), and mastectomy in 6 cases (3%); we also removed a papilloma from the ductal orifice in 1 case (0.44%). Histological specimens showed papilloma in 98 cases (43%), breast cancer in 39 cases (17%), galactophoritis in 36 cases (16%), fibrocystic disease in 46 cases (20%), including 31 (14%) with florid adenosis, and papillomatosis in 8 cases (4%). An increased probability of cancer is therefore associated with serous, bloody, reddish brown and watery secretions. This is particularly true when the secretion is unilateral and originates from a single duct, when there are cytological alterations, whether mammographic or galactographic, and when the patient is aged over 50 years.