Nipple discharge is the third most common clinical complaint among females with breast-related symptoms which often is due to benign causes like duct ectasia or papilloma. However, the risk of associated malignancy increases if the discharge is spontaneous, bloody or serous, persistent, or unilateral, from a single duct and with associated lump. The most common associated malignancy is ductal carcinoma in situ (DCIS). The clinical examination aims to determine when imaging assessment should be included in the patient workup. Although mammography (MG) is routinely performed first, it has low sensitivity in detecting the cause of nipple discharge especially if the lesion is small, in retroareolar location, and has no internal microcalcifications. On the other hand, ultrasound (USG) has variable sensitivity and specificity as it is an operator-dependent technique and needs various maneuvers to assess retroareolar location. Magnetic resonance imaging (MRI) has been used for patients with suspicious nipple discharge but no abnormality on MG or USG, to rule out DCIS which is seen as nonmass enhancement on MRI. The treatment approach for nipple discharge includes microdochectomy, vacuum-assisted excision, or surgical excision, based on specific scenarios. This chapter aims to highlight all these concerns related to diagnosis and management of patients with nipple discharge.