Synopsis
Develop the ability to characterise nipple discharge and inversion by laterality, spontaneity, duct pattern and associated signs so concerning presentations receive timely triple assessment, while explaining uncertainty and arranging reliable review.
- Establish whether discharge is spontaneous, unilateral, single-duct and clear or blood-stained; these features carry more concern than fluid produced only by squeezing several ducts.
- Ask about pregnancy, lactation, menopause, medicines that raise prolactin, breast trauma, infection symptoms and the onset of nipple inversion or eczema.
- Inspect nipple and areola for the involved duct, blood, ulceration, Paget-like change or abscess, then examine retroareolar tissue and regional nodes.
Investigation priorities
Identify the involved duct, inversion, eczema, ulceration, mass or inflammation.
Management branches
A 58-year-old has spontaneous blood-stained discharge from one duct of the right nipple and recently noticed slight inversion; no definite mass is palpable.
- Confirm spontaneity, laterality, colour, single-duct origin, duration and medicine or lactation context; inspect for eczema, ulceration, infection and occult mass.
- Recognise that unilateral bloody discharge with a new nipple change meets a concerning pattern even without a palpable lump and arrange suspected-cancer pathway assessment.