Most of the nipple discharges are not due to cancer but they need investigations to rule it out. This is particularly important if the discharge is spontaneous, ongoing, coming out of one spot, blood stained or clear straw colour. If the investigations are normal but the suspicious discharge continues, some patients need the surgical removal of the relevant duct system known as microdochectomy. Papillary lesions are growths in the main ducts of the breasts and sometimes cause nipple discharge. Usually they need removal to rule out papillary cancer even though most of them are innocent papilloma.