18523 Corwin Rd.
Apple Valley, CA  92307		 Victor Valley Advanced Imaging - (760) 242-4444 PH: (760) 242-4444
FX: (760) 242-7288

 

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Nipple discharge

Nipple discharge can be an early symptom of breast cancer, but most cases of nipple discharge are due to benign conditions. The following are guidelines to differentiate benign discharge from discharge that is associated with malignancy:

  • Spontaneous Discharge: Discharge that comes out without squeezing is the only type of discharge of concern. If the discharge only occurs with squeezing, ignore it and stop squeezing your breast. Check your bra or night clothes for evidence of spontaneous discharge. If you see a spot, save it and show it to your doctor.
  • Color: Worrisome discharge is typically either bloody or clear. Discharge that is green, milky, or other colors is almost always of no concern. Note: if you have large amounts of milky discharge and you are not breast feeding, it should be brought to the attention of your physician. Tests should be done to evaluate for the possibility of a pituitary tumor. Milky discharge with squeezing is not of concern.
  • Single verses multiple ducts: If a women squeezes her breast and notes discharge from multiple spots on the nipple, she can be reassured that the discharge is usally nothing to worry about. However, if the discharge is consistently coming from one spot on the nipple, it is of more concern. This observation should be confirmed by her physician (see link to picture).

How we approach the problem of nipple discharge:

First we do complete history and physical examination, and make sure we have an up-dated mammogram. If the examination and recent mammogram are negative, and the discharge is not-spontaneous, we reassure the patient. We suggest that she examine her bra and night clothes for spotting, and if this is observed, she should return for re-evaluation. Otherwise we suggest she be followed at routine intervals.

If the discharge is spontaneous, and is coming from a single duct, the next step is to do a ductogram. A ductogram is a procedure in which contrast material is placed into the duct (under local anesthesia) and an x-ray is taken (see link to picture). If an abnormality is seen in the duct the patient is taken directly to the operating room where the abnormal duct is removed.

If the ductogram is normal and it was done without technical problems, we advise the patient to observe the discharge. If the discharge persists we repeat the ductogram. In cases in which the ductogram does not clarify the cause of the discharge either because of technical problems or patient discomfort, we usually proceed to surgical exploration of duct.

We have used this approach in hundreds of patients with spontaneous single duct nipple discharge with consistently excellent results. In 90% of the cases the biopsy is benign and the discharge stops after the removal of the abnormal duct. These patients are returned to routing follow-up. The majority of cancers that are identified with this procedure are early cancers that have an excellent prognosis.

Ductoscopy :

The ductoscope is a new technology that allows the observer to look directly into the breast ducts. The procedure can be done in the office and seems to be fairly well tolerated. Its role is yet to be defined. However, since most breast cancers start in the ducts, it is exciting to have new technology that allows us to visualize the duct.

Ductal Lavage :

Ductal lavage is a relatively new technique that evaluates a relatively large sample of cells that are washed out (i.e. lavaged) from the ducts. We are concerned about the costs of this procedure. We have so far concluded the limited benefit is not justified by its cost.

 


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Here is a partial list of some of the services we offer:
MRI, MRA, CT, Ultrasound, Vascular Ultrasound, PET/CT, Nuclear Med, Nuclear Cardio, X-Ray, Open MRI, Fluoro, Arthrograms, Mammography, Breast Ultrasound, DEXA, Stereotactic Breast Biopsy, Breast Cancer Reconstructive Surgery, Helical CT, MR Angiography, High Field MRI, Orange County, Mission Viejo, Los Angeles, Anaheim, Santa Ana, Irvine, community, Southern California, California, orthopedic, sports medicine, bone fracture, Bone Density, Bone Densitometer, Osteoporosis, GE Lunar, broken bones, hip, knee, carpel tunnel, spine, back, Radiology, Diagnostics Imaging, Digital Breast MRI, Breast Biopsy, iCAD, DynaCAD, MRI CAD, Mammo CAD, Women's, Women's Imaging, Breast Cancer Screening
Here is partial list of some of the areas we service:
Los Angeles County:
Agoura Hills, Alhambra, Arcadia, Artesia, Azusa, Baldwin Park, Bellflower, Beverly Hills, Big Pines, Burbank, Carson, Century City, Cerritos, Chatsworth, China Town, City of Industry, Claremont, Commerce, Compton, Covina, Culver City, Downtown LA, Downey, Eagle Rock, El Monte, El Segundo, Encino, Gardena, Glendale, Glendora, Granada Hills, Hawaiian Gardens, Hawthorne, Hermosa Beach, Hidden Hills, Highland Park, Hollywood, Inglewood, Irwindale, Japan Town, Korea Town, La Canada/Flintridge, La Crescenta, La Habra, La Mirada, La Puente, La Verne, Lakewood, Lancaster, Lenox, Lomita, Long Beach, Los Angeles, Los Nietos, Lynwood, Manhattan Beach, Marina Del Rey, Monterey Park, Montrose, Northridge, Norwalk, Palmdale, Palos Verdes Estates, Paramount, Pasadena, Pico Rivera, Pomona, Rancho Palos Verdes, Redondo Beach, Reseda, Rolling Hills Estates, San Fernando Valley, San Gabriel, San Marino, Santa Clarita, Santa Fe Springs, Santa Monica, Signal Hill, South Pasadena, Temple City, Torrance, Valinda, Van Nuys, Ventura County, Verdugo City, Walnut, West Covina, West Hollywood, Westlake Village, Westwood, Whittier and all other cities and communities of Los Angeles County.

Orange County:
Aliso Viejo, Anaheim, Balboa Island, Brea, Buena Park, Capistrano Beach, Corona Del Mar, Costa Mesa, Coto de Caza, Cowan Heights, Cypress, Dana Point, El Modena, El Toro, Foothill Ranch, Fountain Valley, Fullerton, Garden Grove, Huntington Beach, Irvine, La Habra, Laguna Beach, Laguna Hills, Laguna Niguel, Lake Forest, Leisure World, Lemon Heights, Los Alamitos, Mission Viejo, Modjeska Canyon, Newport Beach, Orange, Orange Park Acres, Placentia, Rancho San Margarita, Rossmoor, San Clemente, Santa Ana, Seal Beach, Silverado Canyon, Stanton, Sunset Beach, Surfside, Tustin, Villa Park, Westminster, Yorba Linda and all other cities and communities of Orange County.

San Bernardino County:
Adelanto, Apple Valley, Argus, Baker, Barstow, Big Bear, Bloomington, Chino, Chino Hills, Cima, Colton, Daggett, Devore, Earp, El Mirage, Etiwanda, Essex, Fawnskin, Fontana, Forest Falls, Grand Terrace, Harvard, Helendale, Hesperia, Highland, Hinkley, Hodge, Ivanpaw, Joshua Tree, Kelso, Landers, Lenwood, Loma Linda, Lucerne Valley, Ludlow, Montclair, Morongo Valley, Muscoy, Needles, Ontario, Oro Grande, Phelan, Pinon Hills, Rancho Cucamonga, Redlands, Rialto, Running Springs, San Bernardino, Twenty Nine Palms, Upland, Victorville, Wrightwood, Yucaipa, Yucca Valley and all other cities and communities of San Bernardino County.

Riverside County:
Anza, Arlington, Banning, Beaumont, Blythe, Cabazon, Calimesa, Canyon Lake, Cathedral City, Cherry Valley, Coachella, Corona, Desert Hot Springs, Edgemont, El Cerrito, Gilman, Glen Avon, Glenn Valley, Hemet, High Grove, Home Gardens, Homeland, Hot Springs, Idyllwild, Indian Wells, Indio, La Sierra, Lake Elsinore, Lakeview, La Quinta, Mecca, Mead Valley, Meadow Brook, Mira Loma, Moreno Valley, Murrieta, Murrieta Hot Springs, Norco, Nuevo, Palm Desert, Palm Springs, Perris, Quail Valley, Riverside, Rancho Mirage, Ripley, Rubidoux, Sage, San Jacinto, Sun City, Temecula, Temescal Canyon, Thousand Palms, Valle Vista, White Water, Winchester and all other cities and communities of Riverside County.

Imperial County:
Brawley, Calexico, Calipatria, El Centro, Holtville, Imperial, Westmorland and all other cities and communities of Imperial County.

Ventura County:
Camarillo, Fillmore, Moorpark, Ojai, Oxnard, Port Hueneme, San Buenaventura, Santa Paula, Simi Valley, Thousand Oaks and all other cities and communities of Ventura County. 

As well as the following zip-codes: 91302 Calabasas, Hidden Hills, 91304 west hills, 91307 west hills, 91303 Woodland Hills, 91311 Chatsworth, 91312 Chatsworth, 91313 Chatsworth, 91316 Encino, 91324 Northridge, 91325 Northridge, 91326 Northridge, 91327 Northridge, 91328 Northridge, 91329 Northridge, 91330 Northridge, 91356 Tarzana, 91357 Tarzana, 91364 Woodland Hills, 91365 Woodland Hills, 91367 Woodland Hills, 91371 Woodland Hills, 91372 Woodland hills, 91399 Calabasas, 91401 Sherman Oaks, 91411 Sherman Oaks, 91413 Sherman Oaks, 91423 Sherman Oaks, 91495 Sherman Oaks, Plumbing, Burbank (91501,91502,91503, 91504, 91505, 91506, 91507, 91508, 91510, 91521, 91522, 91523, 91526) North Hills 91393, Granada Hills 91394, Mission Hills 91395, Canoga Park 91396, Van Nuys (91404, 91405, 91406, 91407, 91408, 91409, 91410, 91426, 91436, 91470, 91482,91496, 91497,91499) Reseda 91335, 91337, 91343 North Hills, 91344 Granada Hills, 91346 mission hills, Studio City 91607, Universal City 91608, Studio City 91614, Universal City 91618, North Hollywood (91601, 91602, 91603, 91604, 91605, 91606, 91609, 91610, 91611, 91612, 91615, 91616, 91617, Santa Clarita, 91310, 91321, 91322, 91350, 91351, 91354, 91355, 91380, 91381, 91382, 91383, 91384, 91385, 91386, 91387, 91390, Valencia, 91354, 91355, 91380, 91385, Saugus, 91350, 91390, Newhall, 91321, 91322, 91381, 91382, Stevenson Ranch, 91381, Stevensons Ranch, Stevenson's Ranch, Thousand Oaks, 91319, 91320, 91358, 91359, 91360, 91361, 91362, 91363, Agoura Hills, 91301, 91376, 91377, Westlake Village, 91359, 91361, 91362, 91363, Oak Park, 91301, 91377, Simi Valley, CA:93062, 93063, 93064, 93065, 93093, 93094, 93099, Moorpark, CA:93020, 93021