An abscess is a swollen area in the body that is filled with pus (liquid filled with dead white blood cells). The swelling and pus are due to a local infection. Abscesses in the breast can often occur in lactating women who are breastfeeding.
A breast infection in a breastfeeding woman is usually mastitis. Mastitis is an infection that causes swelling and redness in the breast area, among other symptoms. It can be caused by a clogged milk duct or by bacteria entering the breast through broken skin on the nipple or through a milk duct opening.
One type of breast infection that can occur in non-lactating women is a subareolar breast abscess. Subareolar breast abscesses are infected lumps that occur just under the areola (the colored skin around the nipple). In the past, these infections were called “lactiferous fistulas” or “Zuska’s disease,” after the doctor who first wrote about them.
A subareolar breast abscess is caused by a blocked duct or gland inside the breast. This blockage can lead to an infection under the skin. Subareolar breast abscesses usually occur in younger or middle-aged women who are not currently breastfeeding. Most commonly, they occur following breast jewelry piercings.
When a subareolar breast abscess first develops, you may notice some pain in the area. There will likely be a lump under the skin and some swelling of nearby skin. Pus may drain out of the lump if you push on it or if it is cut open. The infection can then start to form a fistula, an abnormal hole from the duct out to the skin. If the infection is severe enough, nipple inversion can occur. This is when the nipple is drawn into the breast tissue rather than pointing out. You may also have a fever and a general feeling of ill health.
Your doctor will perform a breast exam to assess the lump.
Any pus may be collected and sent to a lab to determine what type of infection you may have. Some bacteria are resistant to certain medications. Your doctor may need to know exactly what kind of bacteria are causing your infection to provide the best form of treatment. Blood tests may also be ordered to look for infection and to check your immune health.
An ultrasound of your breast may also be done to determine what structures under the skin are being affected. Occasionally, a magnetic resonance imaging (MRI) scan may be done as well, especially for a severe or a recurrent infection.
The first stage of treatment is taking antibiotics. Depending on the size of the abscess and your level of discomfort, your doctor may also want to open up the abscess and drain the pus. This would mean the abscess would be cut open in the doctor’s office. Most likely, some local anesthetic will be used to numb the area.
If the infection does not go away with a course or two of antibiotics, or if the infection comes back repeatedly after initially clearing up, you may need surgery. During surgery, the chronic abscess and any affected glands will be removed. If nipple inversion has occurred, the nipple can be reconstructed during surgery.
Surgery may be done in your doctor’s office, in a surgical outpatient center, or in a hospital, depending on the size and severity of the abscess.
Most breast abscesses are cured with antibiotic treatment and/or by having the abscess drained. However, sometimes reoccurring or severe infections require surgery. Most of the time, surgery is successful in preventing the abscess and infection from returning.
Abscesses and infection can reoccur even after treatment with antibiotics. Surgery may be required to remove the affected glands in order to prevent reoccurrence.
Nipple inversion can occur. The nipple and areola can also be deformed or pushed off center by the abscess, causing cosmetic damage, even if the infection resolves with antibiotics. There are surgical solutions to any of these complications.