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Nipple problemsDefinition Nipple problems can include tenderness or discharge from the nipple portion of the breast. (See also intraductal papilloma.) Causes, incidence, and risk factors Nipple tenderness may be caused by inadequate lubricant secretion by the sebaceous glands of the areolar region of the breast or from irritation of the skin from constant excessive moisture that may occur in breastfeeding women. Bacterial or fungal infection of the nipple may also cause nipple tenderness. Tenderness may also result from local trauma or friction over the area. A milky-appearing nipple discharge may normally occur during pregnancy, shortly after delivery, or in breastfeeding women. It may also be caused by a variety of endocrine disorders. Chlorpromazine-type drugs and birth control pills may also cause a milky nipple discharge. Abnormal nipple discharge may be caused by breast cancer (least common cause), intraductal papilloma, and mammary dysplasia with ectasia of the ducts (most common cause). Symptoms
Signs and tests A careful history and physical examinationshould be performed.
Treatment Treatment depends upon an accurate diagnosis of the cause. It may range fromobservation and reassurance, to prescribing medications, to surgery or othertreatments. Expectations (prognosis) Most causes of nipple problems do not involve breastcancer and can be managed or resolved with adequate treatment. Complications A nipple discharge may be a symptomof breast cancer. Calling your health care provider Call for an appointment with your health care provider if nipple problems occur. Prevention Breastfeeding women should be taught to clean the breasts well before and afterfeedings and to use breast pads to help maintain dryness between feedings. Breastcreams may be used to help keep the nipple area lubricated and supple. Illustrations
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