[65F] With unilateral clear nipple discharge post-core biopsy

Patient Description

A 65-year-old female presents with clear, watery nipple discharge from the left breast, typically occurring when squeezed, but recently noted a spontaneous discharge that left a stain on her bra. The discharge began two weeks after a core biopsy performed in July and has persisted since. The patient reports no associated symptoms such as lumps, changes in breast texture, pain, or alterations in breast size or shape. Recent imaging includes an MRI in August showing no suspicious findings (BI-RADS 2) and a mammogram in July revealing an area of architectural distortion in the left breast, correlating with the site of discharge. She is scheduled for a follow-up mammogram and ultrasound in two weeks. The patient is post-menopausal with no recent hormonal changes. Current medications include Seroquel (200 mg daily), Lithium (900 mg daily), Neurontin (800 mg daily), and Xanax (1 mg daily). She has a medical history of bipolar disorder and anxiety disorder, and she is mildly obese, standing 5 feet 3 inches tall and weighing 170 lbs. No known allergies.

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Arora's Assessment

What might be happening

Based on the information you've provided, here are some possible explanations for your nipple discharge:

  • Duct Ectasia: This is a condition where a milk duct beneath your nipple becomes widened and its walls thicken, which can lead to a blocked duct. This is more common in women who are approaching menopause and can cause a clear, watery discharge. Treatment may not be necessary unless it causes discomfort or infection.

  • Papilloma: A small, benign tumor that can form in a milk duct, often causing clear or bloody discharge. These are usually non-cancerous and can be removed surgically if needed.

  • Medication Side Effects: Some medications, including those for mental health conditions like Seroquel, can cause nipple discharge as a side effect. It's important to discuss this with your healthcare provider.

  • Breast Cancer: While less likely given your recent MRI results, it's important to rule out any serious conditions. The upcoming mammogram and ultrasound will help provide more information.

What you can do

  1. Follow Up with Your Doctor: It's important to keep your upcoming appointments for further imaging. These tests will help clarify the cause of the discharge.

  2. Monitor the Discharge: Keep track of any changes in the discharge, such as color, consistency, or frequency. This information can be helpful for your healthcare provider.

  3. Avoid Stimulation: Try to avoid squeezing or stimulating the nipple, as this can sometimes increase discharge.

  4. Use MDandMe: Consider using the MDandMe app to journal your symptoms, track any changes, and share this information with your healthcare provider. This can provide valuable insights into your condition over time.

What you should look out for

  • Changes in Discharge: If the discharge becomes bloody or changes in color, it's important to contact your healthcare provider promptly.

  • New Symptoms: Be alert for any new symptoms, such as lumps, changes in breast texture, or pain, and report these to your doctor.

  • Emotional Well-being: Given your history of anxiety, it's important to manage stress and seek support if you're feeling overwhelmed. Your mental health is just as important as your physical health.

Remember, while I can provide information and guidance, it's crucial to follow up with your healthcare provider for a formal diagnosis and appropriate treatment.

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20 d ago

People Also Ask

What is duct ectasia and how is it treated?

Duct ectasia is a condition where a milk duct beneath the nipple becomes widened and its walls thicken, potentially leading to a blocked duct. It is more common in women approaching menopause and can cause clear, watery discharge. Treatment may not be necessary unless it causes discomfort or infection, in which case antibiotics or surgery might be considered.

Can medications like Seroquel cause nipple discharge?

Yes, medications such as Seroquel, which is used for mental health conditions, can cause nipple discharge as a side effect. It's important to discuss any side effects with your healthcare provider to determine if a change in medication is needed.

What are the signs that nipple discharge might indicate breast cancer?

Signs that nipple discharge might indicate breast cancer include discharge that is bloody, occurs spontaneously without squeezing, or is associated with other symptoms like a lump, changes in breast texture, or skin changes. It's important to follow up with imaging tests like mammograms and ultrasounds to rule out cancer.

How can I manage anxiety related to health concerns?

Managing anxiety related to health concerns can involve several strategies, such as practicing relaxation techniques, seeking support from friends or mental health professionals, staying informed about your condition, and using tools like journaling to track symptoms and feelings. It's important to address both physical and mental health needs.

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