Is nipple discharge normal?
Yes — nipple discharge is often normal, particularly when it comes from several ducts in both nipples and only appears when the nipple is squeezed.
The breast contains around 15 to 20 milk ducts that open onto the nipple, and small amounts of fluid can be expressed from them in many women who are not pregnant or breastfeeding. This physiological discharge is usually:
- Milky, green, yellow, grey or brown.
- From both breasts and from more than one duct.
- Only present when the nipple is squeezed or stimulated.
Discharge is also expected during pregnancy, while breastfeeding and for up to a year or more after stopping. Repeatedly squeezing the nipple to check can keep the discharge going, so it is best to leave it alone and see a doctor if you are unsure.
Most nipple discharge is benign, but discharge that appears on its own, from one nipple, or is bloody or clear should always be checked.
What kind of nipple discharge is concerning?
Nipple discharge is more concerning when it is spontaneous, comes from one nipple and a single duct, and is bloody or clear (watery).
| Feature | Usually benign | Needs investigation |
|---|---|---|
| How it appears | Only when squeezed | Spontaneous, stains clothing or bra |
| Sides | Both breasts | One breast only |
| Ducts | Several ducts | A single duct |
| Colour | Milky, green, yellow, brown | Bloody or clear and watery |
| Other signs | None | A lump, skin change or newly inverted nipple |
| Age | Younger women | Over about 50 (more caution) |
Even discharge with concerning features is most often caused by a benign condition such as an intraductal papilloma. However, it should always be investigated, because a small proportion is linked to an early breast cancer.
What is duct ectasia?
Duct ectasia is a common benign condition in which the milk ducts behind the nipple widen and fill with thick fluid; it often causes a sticky green, brown or black discharge.
It mainly affects women approaching or after the menopause, as the ducts naturally shorten and widen with age. Other possible features include:
- Discharge from several ducts, sometimes from both nipples.
- A slit-like pulling-in of the nipple.
- Tenderness or a small lump behind the nipple.
- Occasionally inflammation or infection.
Duct ectasia is not linked to breast cancer. It often settles on its own. If the discharge is troublesome or keeps causing infection, the affected ducts can be removed surgically.
Can an intraductal papilloma cause bloody nipple discharge?
Yes — an intraductal papilloma is the most common cause of spontaneous, single-duct, bloody or clear nipple discharge.
A papilloma is a small, benign, wart-like growth in a milk duct, usually within a few centimetres of the nipple. It is most common between the ages of about 35 and 55. Sometimes it can be felt as a small lump behind the areola, and pressing that spot may produce discharge.
A single papilloma is benign. It is usually removed, or sampled thoroughly with a needle, because an area of atypical (unusual) cells or, rarely, early cancer can be found within or next to it. Multiple papillomas, usually further from the nipple and in younger women, carry a slightly higher risk and need closer follow-up. Our page on benign breast lumps explains how papillomas fit alongside other non-cancerous conditions.
What causes milky nipple discharge when not breastfeeding?
Milky discharge from both breasts outside pregnancy and breastfeeding is called galactorrhoea, and it is usually caused by a raised level of the hormone prolactin or by a medicine.
Prolactin is the hormone that triggers milk production. Common causes of galactorrhoea include:
- Medicines — some antipsychotics, some antidepressants, anti-sickness medicines such as metoclopramide and domperidone, some blood-pressure medicines, opioids and hormonal contraception.
- Prolactinoma — a benign growth of the pituitary gland in the brain, which may also cause irregular or absent periods, headaches or vision changes.
- Underactive thyroid (hypothyroidism).
- Kidney disease or chronic nipple stimulation, including friction from clothing.
A simple blood test for prolactin, thyroid function and pregnancy usually points to the cause. Treatment depends on the cause, for example changing a medicine or taking medication to lower prolactin. Galactorrhoea is not a sign of breast cancer.
Can nipple discharge be caused by infection?
Yes — infection around the milk ducts can cause pus-like discharge, often with pain, redness and swelling around the nipple.
In breastfeeding women this is usually lactational mastitis. Outside breastfeeding, the most common cause is periductal mastitis, an inflammation of the ducts behind the nipple that is strongly linked to smoking. It may cause:
- Pain and redness around the areola.
- Thick, sometimes bloodstained discharge.
- A tender lump or abscess near the nipple.
- A pulled-in nipple, and sometimes a recurring opening (fistula) at the edge of the areola.
Treatment is with antibiotics and, if an abscess forms, drainage. Stopping smoking significantly reduces the chance of it coming back. Repeated episodes may need surgical removal of the affected ducts. Any red, hot, swollen breast with fever should be seen the same day.
How is nipple discharge investigated?
Nipple discharge is investigated with a breast and nipple examination, an ultrasound and usually a mammogram, with further tests such as MRI or ductography if the cause is still unclear.
- Examination — the doctor looks at the colour of the fluid, which duct it comes from and whether there is a lump. A simple paper strip test can show hidden blood.
- Ultrasound — often shows a widened duct or a papilloma behind the nipple.
- Mammogram — usually from around age 40, to look for calcium deposits or masses.
- Cytology — the fluid can be examined under a microscope, but a normal result does not rule out a problem, so it is used only as an extra test.
- Ductography (galactography) — a fine tube is placed in the discharging duct and contrast dye injected, so the duct shows on a mammogram.
- MRI — used when other tests are normal but discharge is suspicious.
- Biopsy — a needle biopsy of any abnormal area seen on imaging.
In Germany, the usual first step is your Frauenarzt, who can refer you to a Brustzentrum for further imaging; women aged 50 to 75 are also invited to Mammographie-Screening every two years. In Bulgaria you usually start with your GP, who refers you to a mammology specialist. In the UK, your GP can refer you to a breast clinic. Our page on breast cancer diagnosis describes these tests in more detail.
How is nipple discharge treated?
Treatment depends on the cause: physiological discharge needs no treatment, galactorrhoea is treated through its hormonal or medicine cause, and persistent single-duct or bloodstained discharge is often treated by removing the affected duct.
Microdochectomy
A microdochectomy removes a single discharging duct. The surgeon locates the duct, often with a fine probe or dye, and removes it through a small curved incision at the edge of the areola, usually under general anaesthetic as a day case. The tissue is sent to the pathologist, which gives a definite diagnosis. Because only one duct is removed, breastfeeding from that breast is often still possible.
Total duct excision
A total duct excision (Hadfield’s operation) removes all the major ducts behind the nipple. It is used for discharge from several ducts, recurring periductal mastitis or duct ectasia. It usually prevents breastfeeding from that breast and may reduce nipple sensation; it can also flatten the nipple a little. See breastfeeding after breast surgery if this matters to you.
Vacuum-assisted excision under ultrasound guidance is an alternative for some papillomas that are clearly visible on the scan.
Is an inverted or retracted nipple a cause for concern?
A nipple that has always been inverted is usually a normal variation, but a nipple that has recently turned inwards should be checked by a doctor.
Long-standing inverted nipples are common and are often present from puberty in one or both breasts. They are graded by how easily the nipple can be drawn out: grade 1 everts easily, grade 2 everts with effort and goes back, and grade 3 cannot be drawn out. Benign causes of a newly retracted nipple include duct ectasia and periductal mastitis, which often produce a slit-like shape. A nipple that is pulled in at one point, flattened or drawn to one side, especially with a lump, needs prompt assessment, because it can be a sign of an underlying cancer.
Once serious causes have been excluded, a long-standing inverted nipple that bothers you, causes hygiene problems or affects confidence can be corrected with a short procedure under local anaesthetic. Dr. Fatih Kılıç explains the options, including techniques that try to preserve the ducts, on our nipple and areola correction page.
When can nipple discharge be a sign of breast cancer?
Nipple discharge is a sign of breast cancer only in a small proportion of cases, most often when it is bloody or clear, spontaneous, from one duct, and especially in women over 50 or with a lump.
The cancers most often linked with discharge are ductal carcinoma in situ (DCIS) — abnormal cells confined inside the milk ducts — and invasive ductal cancers close to the nipple. A different nipple change, Paget’s disease of the nipple, causes a persistent red, scaly, crusting or itchy rash on the nipple, sometimes with discharge or bleeding, and is often linked to cancer within the breast. A nipple rash that does not settle within a couple of weeks of simple treatment should be checked.
DCIS is a non-invasive, early form of breast cancer, and it is often very treatable; it is explained on our breast cancer types and stages page. Many cases of DCIS are found on a screening mammogram as tiny calcium deposits, before any discharge appears, which is one reason to take up screening when invited.
Normal tests in a woman with discharge are very reassuring. If something is found, decisions about treatment are made by a multidisciplinary breast team. See breast cancer symptoms for the full list of warning signs.
When should I see a doctor about nipple discharge?
See a doctor about any nipple discharge that appears without squeezing, comes from one nipple, is bloody or clear, or comes with a lump or skin change.
Book a prompt appointment if you notice:
- Bloodstained, pink, red or brown-red discharge.
- Clear, watery discharge from a single duct.
- Discharge that stains your bra or nightwear without squeezing.
- A newly inverted, flattened or displaced nipple.
- A lump in the breast or armpit.
- A nipple rash, crusting or scaling that does not heal.
- Milky discharge with missed periods, headaches or vision changes.
- Any nipple discharge in a man.
If the discharge comes with tenderness or aching that follows your cycle, our page on breast pain may also help. Keep a short note of when the discharge appears, its colour and which side it comes from; this helps your doctor.
Seek same-day care for a red, hot, painful breast with fever. The right first step is your GP, family doctor, gynaecologist or breast clinic. A plastic surgeon’s role comes afterwards, for example if duct surgery has changed the shape of the nipple or a long-standing inverted nipple needs correction.
Nipple discharge: local checks first, and when a surgical opinion helps
For patients in Germany, Bulgaria and the UK, nipple discharge should first be assessed locally by your Frauenarzt, GP or breast clinic, where examination and imaging can be arranged quickly. An opinion from Istanbul is relevant afterwards, for example for a long-standing inverted nipple, or a nipple and areola that have changed shape after duct surgery. Istanbul is about 1 hour 15 minutes by air from Sofia and about 3 hours from major German airports. You can share your reports and photographs online for an initial view from Dr. Fatih Kılıç, and after any treatment you receive a written summary for your doctor at home. See international patients or contact us.
Frequently asked questions
Is it normal to have discharge from the nipple when squeezed?
Yes. Small amounts of milky, green, yellow or brown fluid from several ducts in both nipples when squeezed are common and usually normal. It is best to stop squeezing, as this can keep the discharge going.
Is bloody nipple discharge always cancer?
No. Bloody discharge is most often caused by a benign intraductal papilloma. It should always be investigated, though, because a small proportion is linked to DCIS or breast cancer.
What does clear nipple discharge mean?
Clear, watery discharge from both nipples when squeezed is often physiological. Clear discharge that is spontaneous and from one duct should be checked, as it can come from a papilloma or, rarely, cancer.
What causes green or brown nipple discharge?
Green, brown or black sticky discharge is usually caused by duct ectasia or fibrocystic changes. It is typically benign, particularly when it comes from several ducts.
Why do I have milky discharge if I am not pregnant?
Milky discharge outside pregnancy and breastfeeding is called galactorrhoea and is usually caused by raised prolactin. Common triggers are medicines, an underactive thyroid or a benign pituitary growth, and a blood test usually finds the cause.
How is nipple discharge tested?
A doctor examines the breast and nipple, and usually arranges an ultrasound and, from around 40, a mammogram. Ductography, MRI, cytology or a needle biopsy may be added if the cause is still unclear.
What is a microdochectomy?
A microdochectomy is a small operation that removes a single discharging milk duct through a cut at the edge of the areola. It treats the discharge and gives a definite diagnosis, and breastfeeding from that breast is often still possible.
Can I breastfeed after duct excision surgery?
After removal of a single duct, breastfeeding from that breast is often still possible. After total duct excision, breastfeeding from that breast is usually not possible.
Can stress or hormones cause nipple discharge?
Hormonal changes, including the menstrual cycle, pregnancy and the menopause, commonly cause benign discharge. Stress can raise prolactin slightly, but persistent discharge should still be assessed by a doctor.
Is an inverted nipple a sign of breast cancer?
A nipple that has been inverted since puberty is usually normal. A nipple that has recently turned inwards, flattened or changed direction should be checked promptly, as it can occasionally be a sign of cancer.
Should men worry about nipple discharge?
Nipple discharge is uncommon in men and should always be checked by a doctor. It is more often linked to an underlying problem in men than in women.
Medically reviewed by Dr. Fatih Kılıç, Plastic, Reconstructive and Aesthetic Surgeon. This page is for general information and does not replace an individual consultation.