Watery Nipple Discharge – Medical Anecdote – Practice Guidelines – ROJOSON Breast Wellness Clinic

I saw CL in mid-July, 2011.  She is a 56-year-old Filipino female who has been following-up with me for the past 14 years for monitoring and check-up of her right nipple discharge.  The nipple discharge has always been of the character of water, colorless and clear.  Most of time, pressing of the nipple elicits the discharge.  Sometimes, the discharge just comes out spontaneously.  There is NO associated mass.  For the past 14 years, there has been NO progression of symptom, ie, the watery nipple discharge.  It is still there up to now. Before she was referred to me 14 years ago, she was 42 years old then, she was given bromocriptine mesylate (Parlodel), 2.5 mg/tab, twice a day, for 14 days (current price of Parlodel is about P110 per tab, total cost for the patient would be P3,080 for 14 days), with no response.  Other tests that were done on and for her by previous physicians who saw her before me were prolactin (normal result) and smear of the watery discharge (negative for malignancy).  These are commonly observed practices of a lot of physicians in the Philippines, particularly, the non-breast specialists.

My general practice guidelines in patients with watery nipple discharge consist of the following:

1. Start with a clinical diagnosis that is derived at from processing of symptom-data gotten from the interview of patient and sign-data obtained from the physician’s physical examination.

1.1 If the clinical diagnosis is physiologic nipple discharge or nonspecific nipple discharge and the degree of certainty is high (quite certain and with more than 90% probability), the patient is advised on the clinical diagnosis as mentioned above; allayed of fear of breast cancer or other serious breast diseases or disorders; and advised on methods and schedule of monitoring and check-up.  The hallmark of treatment is simply monitoring and check-up collaboratively done by the patient and the physician. There is NO need for diagnostic procedures, such as blood test for prolactin, mammography, ultrasound of the breasts, ductogram (x-ray with dye of the ducts of the breasts), and magnetic resonance imaging of the breasts.  There is NO need for smear with cytologic examination of the discharge.  There is NO need for medications such as bromocriptine besilate (Parlodel – about P110/tab) , danazol (Ladogal – about P134 / tab) and tamoxifen.   Doing all the above mentioned diagnostic procedures and medications would be unnecessary expenses on the part of the patient.

1.2. If the clinical diagnosis of physiologic nipple discharge or nonspecific nipple discharge is NOT certain, as determined by the evaluating physician, then the performance of a diagnostic procedure should be considered.

2. A clinical diagnosis of physiologic or nonspecific nipple discharge is made with a high degree of certainty  if the nipple discharges is of the character of water, colorless and clear, NOT red as to denote blood, AND there is NO palpable mass on the breast.

NOTE: The above guidelines are applicable to patients presenting with watery nipple discharge.  There are instances in which the nipple discharge is of different character and other color.  Practice guidelines may be different.  (Will discuss these in the near future).

Watery nipple discharge, colorless, clear

Red nipple discharge denoting blood

Red nipple discharge denoting blood

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2 Responses to Watery Nipple Discharge – Medical Anecdote – Practice Guidelines – ROJOSON Breast Wellness Clinic

  1. Valencia Iyamu says:

    Enlightening write-up. What specialty are u in? How long have u bn following up d woman? Pls reply

    • rojoson says:

      Thanks for the feedback.
      I am a general surgeon, a surgical oncologist, and a breast specialist in the Philippines with clinic in Manila Doctors Hospital.
      Today, February 23, 2012, the patient followed up with me. Still with watery discharge from her right nipple. No mass. So, no problem. We will continue monitoring. In answer to your question, as of today, the patient has been following up with me for 16 and a half years already.

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