From the Guidelines
Breast implants themselves typically do not cause nipple discharge. Nipple discharge following breast augmentation surgery is uncommon and should be evaluated by a healthcare provider. If discharge occurs after implant placement, it's more likely related to other factors such as hormonal changes, medication side effects, infection, or potentially a pre-existing condition unrelated to the implants. In rare cases, surgical manipulation of breast tissue during implant placement might temporarily affect the milk ducts, but this shouldn't cause ongoing discharge.
Key Considerations
- Any new nipple discharge, especially if it's spontaneous, bloody, from a single breast, or accompanied by other symptoms like pain or lumps, warrants prompt medical attention, as noted in the study by 1.
- This is because nipple discharge can sometimes indicate more serious conditions like infection, inflammation, or rarely, breast cancer.
- Women with breast implants should continue regular breast health monitoring, including appropriate screening and being attentive to any changes in their breasts.
Evaluation and Management
- The evaluation of nipple discharge should consider the characteristics of the discharge, such as whether it is spontaneous, bloody, or from a single duct orifice, as discussed in the study by 1.
- Imaging studies, such as mammography, ultrasound, or MRI, may be necessary to evaluate the cause of nipple discharge, especially if it is pathologic, as recommended in the study by 1.
- The management of nipple discharge will depend on the underlying cause, and may include treatment of any underlying infection or inflammation, or further evaluation and management if a malignancy is suspected.
From the Research
Nipple Discharge and Breast Implants
- Nipple discharge can be a symptom of breast implant rupture, as reported in a case study published in 2020 2.
- The study found that a 45-year-old woman with silicone breast implants presented with clear nipple discharge, which was later diagnosed as a symptom of implant rupture.
- Imaging revealed extensive intraductal and free silicone causing significant stromal deformity secondary to breast implant rupture.
- The patient underwent an oncoplastic excision of free silicone and change of bilateral breast implants.
Diagnosis and Evaluation
- Nipple discharge is a common complaint that can be evaluated with clinical assessment, mammography, and ultrasound 3, 4, 5.
- MRI is increasingly used in the evaluation of pathologic nipple discharge due to its high sensitivity in detecting breast malignancy and its biopsy capability 3, 4.
- The diagnosis of breast implant rupture can be challenging, but MRI imaging with a surface coil is more reliable than ultrasound or conventional MR imaging with a body coil 6.
Management Considerations
- The management of nipple discharge depends on the underlying cause, and breast implant rupture is a possible cause that should be considered 2.
- A thorough history and physical exam are essential in evaluating patients with nipple discharge, and imaging recommendations should be guided by the clinical presentation 4, 5.
- Regular monitoring may be a reasonable alternative to surgery in patients with pathologic nipple discharge and normal imaging assessment 3, 5.