Nipple discharge is a common symptom in breast medicine. It is usually benign in origin (papillomas and galactophore duct ectasia) although it is essential not to miss the risk of an underlying malignant lesion (5%) mostly due to in situ carcinomas. Clinical examination is essential in the management, distinguishing benign “physiological” discharge from discharge suspected of being “pathological” in which further investigations with mammography and ultrasound are required. When the conventional imaging assessment for pathological nipple discharge is normal, breast MRI is gradually replacing galactography although this is still an emerging and invalidated indication. In this context and if the whole imaging assessment is normal, surgery is no longer the only solution for patients, who can now be offered regular monitoring.