Expert: Claes-Gustaf Nordquist, M.D. - 7/2/2006

Question
I was diagnosed with DCIS in Nov 2005, low grade, HR+. I had a lumpectomy in Jan 2006, completed radiation on April 10 and will start Tamoxifen soon.

Since surgery my nipple has been painfully retracted. It got a little better after a few weeks but then worse again during radiation. It's better now, but remains partially retracted. I also have had what I've been told is a benign bilateral discharge for 15 years before the DCIS.  The problem now is that this discharge needs to be cleaned out of the retracted nipple daily, and it is painful. It's constantly irritated because I can't keep it quite as clean as it needs to be. I've been told that this kind of retraction is not likely to go away, and that I'm one of only about 5% of women who have this problem after lumpectomy. One oncologist suggested I have a CT scan of my head, that the discharge may be caused by some sort of pituitary growth. The discharge has only become bothersome because of the retracted nipple. Is there something that can be done surgically? If so, I'm guessing there aren't many surgeons who've done it since the incidence is so low. Do you have any suggestions? Are you familiar with this particular issue?

Thank you.
Andrea

Answer
I know of it but I have never had to deal with it before. I honestly do not know if it is possible to deal with it surgically. My only suggestion is that you discuss this with a good plastic surgeon who is very experienced in breast surgery and that you make it very clear that this is not a matter of cosmetics but a question if it is possible to repair the function of the nipple so that the discharge you have there is not blocked. With the matter of the discharge itself I think that it is best that you discuss that with an endocrinologist, who will have to determine if a CT or MRI scan of your head or anything else is needed! Good luck!