Breast health

“Why, oh why can I still express milk?”

Dixie Mills, MD answers a reader’s e-mail...

Dear Dr. Mills:

I am a white female, age 47. I have two daughters, ages 13 and 11. I nursed my first daughter only six weeks and the second for nearly 12 months. I have always — and to this day — been able to express milk when massaging my breasts and examining them.

Why, oh, why can I express milk? Is this milk? Is it because I keep cupping from behind the milk ducts like when I used to express my breast milk years ago to put into a bottle? How can I still have milk in my ducts ten years after nursing?

I have very small breasts — less than AA cup now, but when when I nursed I was a size D. I am 5'6" and weigh 130 lb — about 5 lb heavier than I’d like to be. I run about three times a week and work out with weights about once or twice a week. My body fat (Tanita Body Fat Scale) is approximately 18%.

The last time I went for a mammogram was June 2005, and I had to come back a second time because my breasts are very dense and there were several spots on both breasts that were marked "questionable" on the June mammogram. After additional images were done it was determined that the “question" was simply a matter of “density" in a small–breasted woman and the film was harder to read.

Thank you for any insight you can provide.

~LN

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Dear L,

Thanks for writing. Being a breast surgeon, I hear stories from women like you fairly often. But it is something most people, women and doctors don’t talk about.

It is fairly common for women to be able to express fluid from their ducts — some researchers say 80% or more of women can, and that frequent massages and squeezing increase the fluid. The fluid is not milk per se but protein, more like the colostrum we produce directly after giving birth, before the richer milk comes in. I am guessing that the color is whitish and that the discharge comes from both breasts and more than one pore.

Because research on the normal breast has lagged behind that on cancer, no one knows exactly what is in the fluid. Dr. Susan Love is doing research on the normal breast now, trying to figure it out and understand what changes to create a cancer, and then how we can detect it really early and treat it more simply — and perhaps figure out how to brush and floss the breast!

Most discharge stops with menopause, so we know it has to do with hormones but the details are still vague! If it bothers you I would recommend holding off on massaging, cupping or expressing the fluid. If it is more than a nuisance, surgery can tie off the ducts but.... If your mammograms are still very dense — not your fault — and you feel a lump, I’d recommend an ultrasound. If you have a family history, maybe an MRI would be useful.

Hope this is helpful.

~Dixie Mills, MD

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Dear Dr. Mills:

I graciously appreciate your prompt and very informative response. I now realize that I am not an anomaly and other women are experiencing the same thing. Your comment about not “expressing” makes perfect sense. Just like when nursing, the more you express, the more you stimulate those ducts.

Thank you again for this information. I look forward to reading your next article!

~LN

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For an in-depth discussion of nipple discharge and what to do about it, please refer back to our full article.

Original Publication Date: 09/27/2006
Last Modified: 02/16/2010
Principal Author: Dixie Mills, MD