Nipple discharge is a common presenting symptom of underlying breast pathology. This study examined the impact of galactography on the evaluation of abnormal nipple discharge. Thirty-five women with spontaneous, unilateral nipple discharge who underwent galactography from 1995 to 1997 were retrospectively studied. Their presenting signs as well as mammographic, galactographic, and pathology findings were evaluated. Nipple discharge was bloody (n = 24), clear (n = 7), or serous (n = 4). A palpable mass was found in 5 patients, and discharge was spontaneous in 29 patients (83%). Mammography was normal in 25 patients (71%). Thirty patients (86%) had an abnormal ductogram that was characterized as a filling defect (n = 20), cutoff sign (n = 5), or ductal dilatation (n = 5). The ductogram demonstrated the location and depth of the lesion in 29 patients (97%). Excision was performed in 27 of 30 patients with an abnormal ductogram: 14 received complete subareolar duct excisions; 12, focused excisions; and 1, excision with a vacuum-assisted biopsy device. Pathology included intraductal papilloma (n = 20) and ductal ectasia (n = 7). Follow-up was completed in 24 patients, including 2 postoperative patients who had persistent discharge on manipulation. In conclusion, galactography is accurate in identifying the location of the ductal abnormality. It allows a focused surgical approach to the pathologic lesion in these patients.