Why Do I Have Black Liquid Coming Out of My Breast?

Causes of black nipple discharge include a benign (non-cancerous) growth within a milk duct (papilloma), a persistently dilated milk duct (duct ectasia), or a chronic abscess near the nipple.

Liquid coming out of the breast is called nipple discharge. It is a normal function of the female breast in during puberty through menopause and it is very common.

Normal nipple discharge is usually milky, yellow, or green in appearance and it is generally not a cause for concern. A milky nipple discharge is also normal during pregnancy and breastfeeding. 

While normal, this type of discharge could be a sign of a hormonal imbalance or change. 

If there is black liquid (black nipple discharge) coming out of the breast, that is often a cause for concern. A black or brown liquid coming out of the breast may indicate blood is present, which can have several causes, such as a benign (non-cancerous) growth within a milk duct (papilloma), a persistently dilated milk duct (duct ectasia), or a chronic abscess near the nipple.

Abnormal nipple discharge alone is rarely associated with breast cancer, but it is important to see a doctor for evaluation and diagnosis if you have black liquid or any abnormal or concerning discharge coming out of your breast. 

Also see a doctor if you have nipple discharge that is persistent or accompanied by other symptoms such as a lump in the breast or ulceration or inversion of the nipple.

Other Causes of Nipple Discharge

There are many causes of abnormal nipple discharge that may be black or other colors, such as:

• Duct ectasia
  • The milk ducts under the nipple enlarge and there is inflammation in the walls of the ducts
  • The condition is benign and it usually happens after menopause
  • Discharge is usually from both breasts (bilateral), and the color is yellow, green or brown
• Duct papilloma
  • A growth within a milk duct in the breast, usually near the nipple
  • Usually comes from a single duct and from one breast only (unilateral)
  • In rare cases, may be associated with breast cancer 
• Nipple eczema or dermatitis that affects the skin of the nipple
  • If it becomes infected, can cause weeping, crusty nipple discharge
• Breast cancer
  • An uncommon cause of nipple discharge
  • Fewer than 5% of women with breast cancer have nipple discharge
  • Usually accompanied by other symptoms, such as a lump or newly inverted nipple
• Paget’s disease of the nipple
  • A type of breast cancer that affects the nipple
  • May be associated with blood-stained nipple discharge
  • Usually causes ulceration and erosion of the nipple skin
• Galactorrhea 
  • A milky nipple discharge that is not related to pregnancy or breastfeeding, caused by abnormal production of the hormone prolactin 
  • May be caused by a disease of the glands that control hormone secretion, such as the pituitary and thyroid glands
• Some medications
  • Some drugs can cause abnormally high prolactin levels 
  • Oral contraceptives
  • Hormone replacement therapy
  • Medications used to treat nausea, depression, and psychiatric disorders.
  • Cocaine
  • Stimulants 

The cause of black liquid coming out of your breast is diagnosed with a patient history and physical examination. 

Testing to determine the cause of black nipple discharge may include: 

• Imaging tests
  • Mammogram 
  • Breast ultrasound
  • Ductogram (a specialized X-ray)
  • Magnetic resonance imaging (MRI) scan
• Testing of a sample of the discharged fluid 
• Biopsy 
• Surgery may be needed for bloodstained nipple discharge to explore the ducts under the nipple to rule out abnormalities not seen on tests

Treatment for black liquid coming out of your breast depends on the cause. 

Normal nipple discharge usually does not require any treatment. 

Abnormal nipple discharge caused by duct ectasia usually does not require treatment. If the discharge becomes bothersome, surgical removal of the ducts behind the nipple may be warranted. 

Treatment for abnormal nipple discharge caused by a duct papilloma depends on the size, if there is more than one, and if it’s causing symptoms. Surgery to remove the duct papilloma and the part of the duct they’re in may be recommended. 

Treatment for abnormal nipple discharge caused by nipple eczema or dermatitis that affects the skin of the nipple is the same as for eczema elsewhere on the body and may include: 

• Identifying and avoiding triggers 
• Keeping the skin hydrated
• Wet dressings (wet wraps) to help soothe skin
• Medications 
  • Over-the-counter (OTC) or prescription topical steroid creams or ointments 
  • Over-the-counter (OTC) or prescription oral antihistamines for itching 
  • Oral steroids (e.g., prednisone) to treat severe flares
  • Tacrolimus ointment (Protopic) and pimecrolimus cream (Elidel)
  • Injectable biologics 
  • Immunosuppressive drugs 
• Ultraviolet light therapy (phototherapy) for severe eczema 

Treatment for abnormal nipple discharge caused by breast cancer or Paget’s disease of the nipple may involve one or more of the following: 

• Surgery
• Radiation therapy 
• Chemotherapy 
• Hormone therapy 
• Targeted therapy
• Immunotherapy

Treatment for abnormal nipple discharge caused by galactorrhea depends on the cause and may include: 

• Medications
• Surgery

Treatment for abnormal nipple discharge caused by certain medications involves changing the dose or regimen of the drug, or stopping the medication. Never stop using a prescribed medication without first talking to your doctor.