- DEFINITION:
The discharge of fluids of different colors and consistency from the nipple outside of pregnancy and breastfeeding is called nipple discharge.
- FREQUENCY:
Nipple discharge is seen in 4.5-7.4% of patients applying to breast polyclinics and is the third most common problem after breast pain and mass. It is a common complaint.
Although nipple discharge is mostly due to benign causes, it can be alarming for patients and physicians as it can rarely occur as an early sign of breast cancer.
- REASONS :
- CLASSIFICATION:
Nipple discharges are evaluated in two groups according to their clinical characteristics
1-Physiological (benign, benign Nipple discharge: It usually occurs due to benign causes. These are mostly discharges from both breasts and from multiple ducts in one breast. It mostly occurs by squeezing the nipple. Its color may vary from white milk color to yellow, brown, green and black.
2-Pathological nipple discharge: It usually comes from a single breast and a single canal without squeezing the nipple and its color is They are mostly bloody or transparent like water. Patients often notice their disease by seeing the stain on their bra.
- DIAGNOSIS:
The lesions that cause nipple discharge are usually very small. Since they are small in size, it is very difficult to diagnose them with imaging methods. Mammography, Ultrasonography and MRI can provide valuable information. However, this information may not be sufficient to make a definitive diagnosis. Galactography is the process of imaging the internal structure of the duct by introducing radiopaque material into the milk duct. Although it is a difficult procedure to perform, it can provide important information for diagnosis.
The most important diagnostic method in nipple discharge is DUCTOSCOPY, which is a microendoscopic method that allows direct visual visualization of the inside of the milk ducts. process. Thanks to this method, the inside of the very thin milk ducts can be seen with the naked eye. Biopsies can be taken from lesions inside the canals. The inside of the milk ducts can be washed and cancer cells can be searched for in the washing fluid (cytology). If a successful DUCTOSCOPYexamination can be performed, the lesion causing nipple discharge will be diagnosed to a large extent. DUCTOSCOPY has been applied in our country by Prof. Dr. Ömer Bender since 2005. Apart from diagnosis, DUCTOSCOPY can also be used for treatment purposes. Intraductal papillomas, the most common cause of nipple discharge, can be treated non-surgically for the first time in the world with the method invented by Prof. Dr. Ömer Bender. Thanks to this method, some intraductal papillotes can be removed endoscopically from the milk duct.
- TREATMENT:
Since pathological nipple discharge carries a risk of cancer. All over the world, the patient is treated by surgically removing the milk duct (ductus excision). However, since cancer or a pathological lesion is detected in very few of the operated patients, a significant portion of the patients undergo unnecessary surgery. In order to prevent these unnecessary surgeries, patients with pathological nipple discharge should first be examined within the milk ducts by ductoscopy, and it is appropriate for patients with pathological lesions to be operated on and patients without lesions to be followed closely. When this is done, unnecessary surgery will not be performed for papillomas that can be removed endoscopically.
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