Evaluation of Treatment Strategies for Male Prolactin-Secreting Pituitary Neuroendocrine Tumors.

Prolactin-secreting pituitary neuroendocrine tumors (PitNETs) are more common in women. Male patients may also have few symptoms and have macroadenomas extending outside the sella turcica. This study aimed to report the results of cabergoline treatment in male patients with prolactin-secreting PitNET. The study included nine male patients aged 26-65 years (median, 46 years) diagnosed with prolactin-secreting PitNETs. The age at onset, prolactin values, tumor size, symptoms, and treatment were assessed. The mean prolactin value at the initial presentation was 2734.6 ng/mL, and the mean maximum tumor diameter was 40.4 mm. Visual field disturbance was the most common symptom (44.4%), followed by headaches (33.3%), asymptomatic symptoms (11.1%), and galactorrhea (11.1%). Eight patients responded to cabergoline treatment with normalization of prolactin levels and tumor shrinkage. One patient did not respond to the cabergoline treatment and required surgical intervention. There were no cases of cerebrospinal fluid leakage. Cabergoline was found to be an effective treatment for male prolactin-secreting PitNETs.

The curious case of milk collection under skin graft over the breast: Lessons learned!

Raw area on the breast, especially when it is lactating, can lead to complications, including hyperprolactinemia and development of milk fistulae. A 25-year-old female presented with raw area over the left breast after 2 months of childbirth. She had history suggestive of necrotizing disease, which had primarily been managed elsewhere with debridement and dressings. We excised the raw area and applied split thickness skin grafts with minimal meshing. Bulky dressing prevented breastfeeding. On postoperative day 3, there were blebs containing milk underneath the graft. The blebs were drained and oral cabergoline was administered for 3 months. The skin graft healed well. If expression of breast milk is not possible then suppression of lactation should be considered before definitive cover of the raw area of breast.

Galactorrhea after breast augmentation: case report and literature review / Galactorreia após mamoplastia de aumento: relato de caso e revisão da literatura

Introduction: Augmentation mammoplasty is one of the most frequently performed surgeries in plastic surgery. Among its rarer occurrences are galactorrhea, spontaneous milk output by the papilla, and galactocele, a collection of milky material in the surgical bed. There is little literature on this extremely rare occurrence, and through this article, we conduct a literature review and report on a case operated in our service. Case Report: We present a case of a 35-year-old patient who underwent breast augmentation surgery via the inframammary fold, with an implant placed in the subglandular plane, which evolved, on the thirtieth postoperative day, with galactorrhea exteriorized through the incision, and we propose a treatment for such intercurrence. Six months after the operation, the breasts were symmetrical, without signs of contracture or additional alterations; the patient was satisfied with the result and without new episodes of galactorrhea or galactocele. Conclusion: Although rare, with an incidence of less than 1%, galactorrhea can occur as a postoperative complication, and knowledge about it, as well as the forms of treatment, will benefit both patient and surgeon.

Introdução: A mamoplastia de aumento é uma das cirurgias mais frequentemente realizadas na cirurgia plástica. Entre suas intercorrências mais raras, está a galactorreia, saída de leite pela papila de forma espontânea, e o galactocele, uma coleção de material leitoso no leito cirúrgico. Pouca literatura existe sobre esta raríssima intercorrência e por meio deste artigo realizamos uma revisão da literatura e relato de um caso operado no nosso serviço. Relato de Caso: Apresentamos um caso de uma paciente de 35 anos que foi submetida a cirurgia de mamoplastia de aumento via sulco inframamário, com implante alocado no plano subglandular, que evoluiu, no trigésimo dia pós-operatório, com galactorreia exteriorizada pela incisão, e propomos um tratamento para tal intercorrência. Com seis meses de pós-operatório, as mamas se encontravam simétricas, sem sinais de contratura ou alterações adicionais, paciente satisfeita com o resultado e sem novos episódios de galactorreia ou galactocele. Conclusão: Embora rara, com uma incidência de menos de 1%, a galactorreia pode ocorrer como intercorrência pós-operatória e o conhecimento desta, bem como as formas de tratamento, irá beneficiar tanto paciente como cirurgião.

Galactorrea y galactocele: factores de riesgo e implicaciones en el aumento de mama / Galactorrhea and galactocele: risk factors and implications for breast augmentation

Introducción y objetivo: El aumento de mama es el procedimiento quirúrgico estético más realizado en mujeres en todo el mundo. La galactorrea es una complicación rara posterior al aumento mamario con implantes, con una incidencia del 0.96% y solo 38 casos reportados en la revisión sistemática más reciente del 2021, aunque con posibles consecuencias a corto y largo plazo altamente significativas. Presentamos nuestra serie de casos de galactorrea asociada a colocación de implantes de mama y revisamos las publicaciones sobre el tema con la finalidad de comprender la fisiopatología y establecer un protocolo de prevención, diagnóstico y tratamiento oportuno y efectivo en estos casos. Material y método: Revisión retrospectiva documental y fotográfica de nuestra experiencia en 5 años con aumento de mama primario y galactorrea, así como búsqueda en PubMed, Embase y Google Académico con las palabras claves en inglés: Galactorrhea, Galactocele, Breast augmentation, Augmentation mammoplasty, Breast implants adverse effects. Resultados: Entre 2015 y 2020 se realizaron en nuestra clínica de la Ciudad de México 2.232 procedimientos de aumento de mama, entre los cuales evidenciamos galactorrea / galactocele en 7 pacientes (incidencia del 0.31%) que requirieron estrategia diagnóstica y de tratamiento farmacológico / quirúrgico. En la búsqueda bibliográfica encontramos 20 artículos: 17 series de casos, 2 revisiones retrospectivas y 1 revisión sistemática. Conclusiones: Con la información disponible, evidencia existente y nuestra experiencia proponemos una pauta sencilla y completa para determinar factores de riesgo preoperatorios, abordaje diagnóstico y niveles terapéuticos efectivos para disminuir las posibles complicaciones a corto y largo plazo de la galactorrea / galactocele asociados al aumento de mama con implantes. (AU)

Background and objective: In women, breast augmentation is the most performed aesthetic surgical procedure in the world. Galactorrhea is a rare complication after breast augmentation with implants, with an incidence of 0.96% and only 38 cases reported in the most recent systematic review of 2021, although with possible highly significant short- and long-term consequences. We present our series of cases of galactorrhea associated with the placement of breast implants and review the publications on the subject to understand the pathophysiology and thus establish a protocol or guideline for timely and effective prevention, diagnosis and treatment in these cases. Methods: A documentary and photographic retrospective review of our 5-year experience with primary breast augmentation and galactorrhea was carried out, as well as a search in PubMed, Embase and Academic Google with the keywords in English: Galactorrhea, Galactocele, Breast augmentation, Augmentation mammoplasty, Breast implants adverse effects. Results: Between 2015 and 2020, in our clinic in Mexico City, 2.232 breast augmentation procedures were performed, of which we evidenced galactorrhea / galactocele in 7 patients (0.31% incidence), who required a more complex diagnostic strategy and pharmacological / surgical treatment. In the search for information in the literature we found 20 articles: 17 case series, 2 retrospective reviews and 1 systematic review. Conclusions: With the available information, existing evidence, and our experience we propose a simple and complete guideline for the determination of preoperative risk factors, diagnostic approach and effective therapeutic levels to reduce the possible short and long-term complications of surgery in galactorrhea / galactocele associated with breast augmentation with implants. (AU)

Galactorreia pós-mastopexia com prótese: relato de caso / Post-mastopexy galactorrhoea with a prosthesis: a case report

A mastopexia é a cirurgia plástica responsável pela correção da ptose mamária, problema caracterizado pela discrepância entre o volume da mama e sua camada cutânea. As complicações mais relatadas no pós-operatório imediato são deiscência de suturas, seroma, edema e infecção, enquanto outras, como a galactorreia, são consideradas raras. O caso em questão consiste em uma paciente de 52 anos, que realizou a mastopexia bilateral com inclusão de prótese e desenvolveu após 30 dias do procedimento galactorreia com hiperprolactinemia. O diagnóstico foi suspeitado devido ao aumento de volume, associado a dor ou desconforto mamário no pós-operatório, seguido de saída secreção leitosa. A galactocele pósmastopexia com prótese pode ou não estar associada à hiperprolactinemia, porém pouco se sabe sobre a real fisiopatologia do desenvolvimento desse quadro. O tratamento foi feito com cabergolina 0,5mg em duas doses, com melhora do quadro.

Mastopexy is the plastic surgery responsible for correcting breast ptosis, a problem characterized by a discrepancy between the volume of the breast and its skin layer. The complications most commonly reported in the immediate postoperative period are suture dehiscence, seroma, edema and infection, while others such as galactorrhea are considered rare. The case in question consists of a 52-yearold patient who underwent bilateral mastopexy with prosthesis inclusion and developed galactorrhea with hyperprolactinemia 30 days after the procedure. The diagnosis was suspected of increased volume, associated with postoperative breast pain or discomfort, followed by milky discharge. Galactocele after mastopexy with a prosthesis may or may not be associated with hyperprolactinemia, but little is known about the real pathophysiology of the development of this condition. Treatment was done with cabergoline 0.5mg in two doses, improving the condition.

A rare endocrinological complication of chronic kidney disease.

BACKGROUND: Chronic kidney disease (CKD) may lead to increase in serum levels of peptide hormones as a result of changes in peripheral metabolism. The pathogenesis of uremic hyperprolactinemia in CKD is not fully understood. Plasma prolactin levels are elevated in women, pubertal girls, and also in men with chronic kidney disease. But this is not comon in prepubertal boys. Also in prepubertal children and postmenopausal women, hyperprolactinemia rarely results in galactorrhea. We aimed to discuss hyperprolactinemia and galactorrhea in a 12-year-old male with CKD. CASE: A twelve-year-old boy with chronic kidney disease (CKD) suffered from bilateral galactorrhea. He was on follow-up at Pediatric Nephrology Department from the age of two due to bilateral dysplastic kidney. On physical examination, his weight was - 0.59 SDS, height was -2.82 SDS, Blood pressure was 115 / 72 (75p), stretched penis length was 6 cm, testicular volume was 3mL / 3mL, pubic hair was Tanner Stage 1, breast examination did not reveal plaque on bilateral breast. He was receiving recombinant erythropoietin, sodium bicarbonate, polystyrene sulfonate, calcium acetate, and calcitriol treatments. Glomerular filtration rate was 23ml/min/1.73 m2 (CKD stage IV). Serum prolactin (PRL) was > 200 µg/L (N, 2.64-13.13). The pituitary adenoma was excluded with pituitary and cranial magnetic resonance imaging (gadolinium). Cabergoline (0.5 mg/ twice weekly) was initiated to decrease PRL levels and reduce galactorrhea. In the second week of treatment, serum PRL level was suppressed (0.4 µg/L) and galactorrhea was completely resolved. CONCLUSIONS: Although uremic hyperprolactinemia is very rarely seen in childhood, it is important to evaluate, and initiate an appropriate treatment since it is associated with delayed puberty and infertility in adulthood in many cases.

Proton pump inhibitors therapy and risk of hyperprolactinemia with associated sexual disorders.

Proton pump inhibitors (PPIs) are the most widely prescribed medications in the world. According to numerous studies, PPIs have been linked to hyperprolactinemia, which can lead to a variety of sexual and reproductive issues. This review summarizes the effects of numerous PPIs on the blood prolactin levels and associated sexual dysfunctions, which have an effect on the patient's life quality and fertility. The study is taken into account all the available resources till January 31, 2021. Out of total 364, only 27 relevant resources were involved in this review. In certain studies, short-term PPIs use has been shown to have little or no effect on the blood prolactin and other reproductive hormones levels. PPIs have been linked to the development of hyperprolactinemia in several case studies with varying degrees of the blood prolactin levels increase seen in individuals taking PPI alone or in combination with medications, like prokinetics. The relative risk of the sexual consequences development, such as gynecomastia, has been documented using lansoprazole and omeprazole in various cohort studies. On the other hand, other bits of data are insufficient to establish a definite relationship that can turn a possibility into certainty. The majority of the literature data is comprising of double-blind, randomized, crossover studies, case reports, and adverse drug reaction incidents reported to various pharmacovigilance centers. To investigate this link, high-quality studies in patients taking PPIs for a longer time period are needed. We conclude this article with a comprehensive discussion of the hyperprolactinemia clinical implications and the PPIs' function.

Omeprazole-induced galactorrhea in kidney transplant patients-a case report.

BACKGROUND: Omeprazole belongs to the pharmacological classifications of proton pump inhibitors and is a widely used medicine. All proton pump inhibitors have a common mechanism of action and are prodrugs that require activation in an acidic environment. Omeprazole is extensively metabolized in the liver by cytochrome 2C19 and cytochrome 3A4, which are responsible for drug interactions. Omeprazole-induced galactorrhea is a rare adverse event of drug metabolism and is often underreported. CASE PRESENTATION: This is a case of a 26-year-old unmarried Asian (Bhutanese) female who underwent kidney transplant and was administered standard antirejection medication (tacrolimus, prednisolone, and leflunomide) along with an antihypertensive agent. She came to the emergency department with complaints of nausea, vomiting, abdominal pain, chronic gastritis, anemia, hypertension, and loss of appetite. The tacrolimus trough level was in the subtherapeutic range at admission. The tacrolimus dose was adjusted, and oral omeprazole was administered. After 3 days, she experienced milk production from her left breast, which according to the patient was her second incidence after omeprazole ingestion. CONCLUSION: Causality assessment using Naranjo's algorithm and recovering from galactorrhea after stopping omeprazole and omeprazole rechallenge with the reappearance of galactorrhea confirmed omeprazole as the causative agent. Tacrolimus interferes with omeprazole metabolism and increases tacrolimus levels in the blood. Caution needs to be taken when omeprazole is administered with other drugs that interfere with metabolizing enzymes.

Hyperprolactinemia and galactorrhea associated with the use of duloxetine to treat chronic neuropathic pain. Case report / Hiperprolactinemia e galactorreia associada ao uso de duloxetina para tratamento de dor neuropática crônica. Relato de caso

ABSTRACT BACKGROUND AND OBJECTIVES: The association of the use of some drugs with hyperprolactinemia and galactorrhea has been reported in the literature, but information on the role of duloxetine in these alterations is scarce. Therefore, the aim of this study was to highlight this adverse effect and discuss the pathophysiological causes of galactorrhea associated with the use of duloxetine in a patient undergoing treatment for chronic pain. CASE REPORT: Female patient, 70 years old, with herpetic neuropathy diagnosis. She developed refractory pain after drug treatment and was referred to the pain clinic. Duloxetine (60mg) taken once a day was maintained and associated with blocks with local anesthetic in regions of herpetic pain. The patient complained of galactorrhea and changes in weight and showed an increase in serum prolactin. Then, the possibility of hyperprolactinemia due to duloxetine was raised. Duloxetine was suspended, and after one month, a significant reduction in serum prolactin levels and end of galactorrhea were observed. CONCLUSION: The treatment of patients with neuropathic pain is extremely challenging and the detailed understanding, especially of the pharmacological strategy and its possible adverse effects, is fundamental for the better management of patients and their well-being. Therefore, it is concluded that duloxetine, although rarely, can cause an increase in serum prolactin and galactorrhea in users.

RESUMO JUSTIFICATIVA E OBJETIVOS: A associação do uso de alguns fármacos com hiperprolactinemia e galactorreia tem sido relatada na literatura, mas são escassas as informações sobre o papel da duloxetina nestas alterações. Portanto, o objetivo deste estudo foi destacar este efeito adverso e discutir as causas fisiopatológicas da galactorreia associada ao uso de duloxetina no tratamento da dor crônica. RELATO DO CASO: Paciente do sexo feminino, 70 anos, com diagnóstico de neuropatia herpética. Evoluiu com refratariedade álgica após tratamento farmacológico, sendo encaminhada à clínica de dor. Optou-se por manter a duloxetina (60 mg) uma vez ao dia e associar bloqueios com anestésico local em regiões de dor herpética. A paciente queixou-se de galactorreia e alteração de peso e apresentou elevação da prolactina sérica. Foi aventada, então, a possibilidade de hiperprolactinemia pela duloxetina. Foi, então, realizada a suspensão da duloxetina e, após um mês, foi observada redução expressiva dos níveis séricos da prolactina e cessação da galactorreia. CONCLUSÃO: O tratamento de pacientes com dor neuropática é extremamente desafiador e a compreensão detalhada do processo, em destaque para a estratégia farmacológica e seus possíveis efeitos adversos é fundamental para o melhor manejo dos pacientes e manutenção do bem-estar. Diante disso, concluiu-se que a duloxetina, apesar de acontecer raramente, pode causar aumento da prolactina sérica e galactorreia em usuários.

Educational Case: Pituitary Adenoma.

The following fictional case is intended as a learning tool within the Pathology Competencies for Medical Education (PCME), a set of national standards for teaching pathology. These are divided into three basic competencies: Disease Mechanisms and Processes, Organ System Pathology, and Diagnostic Medicine and Therapeutic Pathology. For additional information, and a full list of learning objectives for all three competencies, seehttp://journals.sagepub.com/doi/10.1177/2374289517715040.1.

A case report on azathioprine-induced euprolactinemic galactorrhea.

Galactorrhea is characterized as an inappropriate discharge of milk-containing fluid from the breast. It has various causes including physiological and pathological. It may also be caused by many drugs. Although galactorrhea is usually associated with increased serum prolactin levels, it has been reported to occur in the absence of hyperprolactinemia. Cases of azathioprine-induced galactorrhea with normal prolactin level in a 22-year-old female patient with prurigo have been reported. It was noticed that the patient had no history of galactorrhea in the past.

Galactorrhea during antipsychotic treatment: results from AMSP, a drug surveillance program, between 1993 and 2015.

Galactorrhea is a well-known adverse drug reaction (ADR) of numerous antipsychotic drugs (APD) and is often distressing for those affected. Methodological problems in the existing literature make it difficult to determine the prevalence of symptomatic hyperprolactinemia in persons treated with APDs. Consequently, a large sample of patients exposed to APDs is needed for more extensive evaluation. Data on APD utilization and reports of galactorrhea caused by APDs were analyzed using data from an observational pharmacovigilance program in German-speaking countries-Arzneimittelsicherheit in der Psychiatrie (AMSP)-from 1993 to 2015. 320,383 patients (175,884 female inpatients) under surveillance were treated with APDs for schizophrenia and other indications. A total of 170 events of galactorrhea caused by APDs were identified (0.97 cases in 1000 female inpatient admissions). Most cases occurred during the reproductive age with the highest incidence among patients between 16 and 30 years (3.81 cases in 1000 inpatients). The APDs that were most frequently imputed alone for inducing galactorrhea were risperidone (52 cases and 0.19% of all exposed inpatients), amisulpride (30 resp. 0.48%), and olanzapine (13 resp. 0.05%). In three cases, quetiapine had a prominent role as a probable cause for galactorrhea. High dosages of the imputed APDs correlated with higher rates of galactorrhea. Galactorrhea is a severe and underestimated condition in psychopharmacology. While some APDs are more likely to cause galactorrhea, we identified a few unusual cases. This highlights the importance of alertness in clinical practice and of taking a patient's individual situation into consideration.

Selective serotonin reuptake inhibitor-induced galactorrhea with hyperprolactinemia.

Galactorrhea in nonpregnant woman of child-bearing age is related to various pathologies including the use of psychotropic. Although common with antipsychotics, galactorrhea with antidepressants was infrequent. Previously reported cases of galactorrhea were mostly with combined antidepressants and cases of galactorrhea with paroxetine and fluvoxamine were with normal serum prolactin level. We reported three cases of galactorrhea, one with single use of paroxetine and other two with fluvoxamine with elevated serum prolactin level in all three cases.

Galactorrhea Following Minimally Invasive Reoperative Mitral Valve Replacement: An Unexpected Complication.

Galactorrhea, or nonpuerperal lactation, is a rare complication that can occur after trauma to the chest wall. Although galactorrhea has been reported after thoracic surgery, it has not been previously noted as a potential outcome following cardiac surgery. We present a unique case of hyperprolactinemic galactorrhea experienced by a 39-year-old nongravid female patient after having undergone reoperative mitral valve replacement via a right minithoracotomy. To the best of our knowledge, this is the first reported case of spontaneous lactation occurring after cardiac surgery.

Copious watery nipple discharge caused by a discontinuous ventriculoperitoneal shunt.

Breast-related complications of ventriculoperitoneal (VP) shunts are rare. We present a case of a woman with a VP shunt with copious watery nipple discharge following a fall. Shunt discontinuity was identified on a diagnostic mammogram, and the nipple discharge was confirmed to be cerebrospinal fluid (CSF). Symptoms resolved with shunt revision.

Idiopathic granulomatous hypophysitis presenting with galactorrhea, headache, and nausea in a woman: a case report and review of the literature.

BACKGROUND: Inflammation of the pituitary gland can occur in a variety of primary or secondary disorders. Idiopathic granulomatous hypophysitis is a rare inflammatory disease of the pituitary gland that can closely mimic a pituitary adenoma clinicoradiologically. Most authorities agree on minimally invasive transsphenoidal surgery as the mainstay in diagnosis and treatment of this disorder. There is still some controversy regarding pure medical management of idiopathic granulomatous hypophysitis in the literature. CASE PRESENTATION: A 47-year-old Iranian woman of Azeri ethnicity with a history of benign breast cysts with a chief complaint of galactorrhea presented to our endocrinology clinic. Her past medical history was negative for any menstrual irregularities, hirsutism, visual complaints, diplopia, polyuria and polydipsia or seizures. She was taking 100 mcg of levothyroxine daily. Her familial history and physical examination were unremarkable. Her initial laboratory work-up revealed hyperprolactinemia (82.4 ng/mL) with otherwise normal pituitary axes. Brain magnetic resonance imaging showed a pituitary macroadenoma for which she was treated with 0.5 mg of cabergoline weekly. Although her serum prolactin level dropped to 1.7 ng/mL and her galactorrhea was resolved, she continued to complain of headaches and nausea. Repeated imaging showed no decrease in size of the macroadenoma. Therefore, she underwent transsphenoidal surgery of the macroadenoma which was reported as chronic granulomatous hypophysitis by expert pathologists. Tuberculosis, sarcoidosis, Wegener's granulomatosis, Langerhans cell histiocytosis, and syphilis were ruled out by appropriate tests and she was diagnosed as having idiopathic granulomatous hypophysitis. Fortunately, her condition was not complicated by hypopituitarism and she was symptom free 9 months after transsphenoidal surgery. CONCLUSIONS: Idiopathic granulomatous hypophysitis, a rare inflammatory disease of the pituitary gland, is a diagnosis of exclusion for which both medical and surgical management are reported in the literature. We present a case of idiopathic granulomatous hypophysitis who was symptom free with no complications of hypopituitarism following its transsphenoidal resection after 9 months of follow-up.

Ranitidine-induced galactorrhea in a postmenopausal female.

We report a case of drug-induced hyperprolactinemia in a 46 year postmenopausal female presenting as galactorrhea and painful breast engorgement as result of ranitidine exposure. The occurrence of galactorrhea as an adverse effect of ranitidine therapy is scarcely reported in literature and to the best of our knowledge this is first such reported case.

Pituitary macroadenoma resulting from primary hypothyroidism; a 16-year-old girl.

BACKGROUND: Primary hypothyroidism is a common medical condition. It can lead to pituitary adenoma which is usually asymptomatic, but it can also lead to symptomatic macroadenomas which are hard to diagnose due to different clinical presentations. CASE PRESENTATION: A 16-year-old girl presented for endocrinology consultation prior to neurosurgical operation. She had galactorrhea which was accompanied by vertigo & low grade blurred vision without a headache and was diagnosed with pituitary macroadenoma and was planned for a surgery. She had TSH level of more than 100 mU/L, free thyroxine of 1.9 pmol/L. Her thyroid peroxidase (TPO) antibody level was 13.3 IU/mL, insulin growth factor-1 392 µ/l and serum prolactin level 42 ng/ml. During physical exam and with the laboratory findings, we suspected for a primary hypothyroidism as the leading cause of pituitary macroadenoma. As the result, we cancel the surgery and start levothyroxine therapy 100µg daily for her. In the follow-up it revealed that our diagnosis was correct and she went into remission with pituitary gland shrinking and decreasing TSH and prolactin levels. CONCLUSION: It is important to understand the different presentation of primary hypothyroidism to decrease the unnecessary risk of maltreatment in patients.

Nipple Discharge After Nipple-Sparing Mastectomy With and Without Associated Pregnancy.

BACKGROUND: Nipple-sparing mastectomies (NSMs) preserve the intact nipple, including nipple duct orifices. Retained orifices might remain patent and communicate with the underlying reconstruction. We report the incidence and outcomes of nipple discharge after NSM in pregnant and nonpregnant women. PATIENTS AND METHODS: Retrospective review of all NSMs at our institution from June 2007 to June 2018 was performed. Subsequent pregnancies and nipple discharge were documented. Patient demographic, operative, histopathology, and cancer treatment data were collected. Descriptive analysis was performed for patients who developed nipple discharge. RESULTS: From June 2007 to June 2018, 2778 NSM procedures were performed in 1620 patients, with a mean age of 48 (range, 20-80) years. Fifteen hundred sixty-eight NSMs were therapeutic and 1210 were for risk reduction. Thirty-three subsequent pregnancies were observed in 27 patients, with a mean age of 33 (range, 26-42) years at NSM. Bilateral or unilateral discharge occurred in 6 of 27 (22%) postpartum patients and resolved spontaneously. At 54 months mean follow-up after NSM (range, 16-98 months) and 23 (range, 1-61) months after delivery, no local-regional recurrences were observed. In 1593 patients without subsequent pregnancy, there were 4 patients (0.25%) treated with bilateral NSM with subsequent unilateral watery nipple discharge. There was no evidence of associated malignancy on physical exam, imaging, or cytology, and with 55 to 110 months follow-up, no new or recurrent cancers have been observed. CONCLUSION: Despite extensive removal of nipple and subareolar duct tissue during NSM, milky nipple discharge is possible postpartum. Watery, acellular discharge occurs rarely in nonpregnant patients. To date, no patient with discharge has developed a local recurrence or new breast cancer.