Virginia Commonwealth University Breast Imaging

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We recommend a ductogram when there is nipple discharge that comes on its own (spontaneous), regardless of its appearance. In this case, you may notice dark brown spots on your bra or night clothes or you may notice fluid coming from your nipple after a hot bath or shower. On physical examination, fluid is obtained easily and consistently from one duct opening.

You should note that milky discharge can be seen for several years following childbirth or after breast-feeding is stopped. This type of discharge may come on its own but it is usually milky white and comes from multiple duct openings on both nipples.

About the Procedure

During a ductogram, you are asked to lie on your back while we try to express nipple discharge so that we can identify where on your nipple the discharge is coming from. A tiny blunt-tipped needle is then advanced into the duct with the discharge and a few drops of contrast are injected into this duct. Images of your breast are done so that we can evaluate the inside of the duct highlighted by the contrast material.

Your Results

The most common causes of spontaneous nipple discharge include:

  • Benign papilloma (approximately 50 percent of patients)
  • Benign fibrocystic changes (approximately 35 percent of patients)
  • Benign duct ectasia
  • Breast cancer

If a lesion is identified inside the duct, we may recommend that it be surgically removed.

Nipple discharge that is seen only with expression — when you squeeze or otherwise manipulate the nipple — is not usually related to an underlying problem. It is normal for most women to have some fluid in the milk ducts. We recommend that you not try to express nipple discharge, but that when you do laundry you get in the habit of checking your bra cups and night clothes for spots that may indicate spontaneous discharge.

A view of a normal ductogram.

A ductogram is a test used to evaluate patients who have spontaneous nipple discharge. A tiny, blunt-tipped needle is used to inject two or three (0.2-0.4 mL) drops of contrast in order to study the inside of the duct. In this patient, the contrast (white) outlines the course of a duct (arrows) that is normal in width. No lesions, or filling defects, are present.

A view of an abnormal ductogram.

In this patient, contrast outlines (single arrows) a duct that is wider than normal (dilated), and the contrast column is disrupted by the presence of a tumor (double arrow). About half of the patients presenting with spontaneous nipple discharge are found to have papillomas, which are benign, non-cancerous tumors. The tiny, blunt-tipped needle used to inject the contrast is seen at the edge of the film (wide arrow).

Virginia Commonwealth University Medical Center VCU Breast Imaging