Most breast infections occur in people who are breastfeeding. A subareolar breast abscess is a rare type of breast infection that can also occur in nonlactating people.

An abscess is a swollen, pus-filled area of the body. Subareolar breast abscesses are infected lumps that occur just under the areola, the colored skin around the nipple.

The swelling and pus are the result of a local infection, which occurs when bacteria invade the body at a certain point and remain there. In a local infection, the bacteria don’t spread to other parts of the body.

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’s cut open.

If left untreated, the infection can start to form a fistula. A fistula is a connection between two body parts or organs that don’t normally connect (in this case, the milk ducts and skin).

If the infection is severe enough, the nipple may be drawn into the breast tissue rather than point out. This is called nipple inversion.

You may also have a fever and a general feeling of ill health.

DID YOU KNOW?

In the past, subareolar breast abscesses were called lactiferous fistulas or Zuska’s disease. Zuska was 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 women who are between ages 18 and 50 years old and aren’t currently breastfeeding.

Some risk factors for subareolar breast abscesses in nonlactating women include:

Mastitis

Subareolar breast abscesses are more common in people who aren’t breastfeeding, but most breast abscesses occur in lactating people who are breastfeeding.

Mastitis is a type of breast inflammation that causes symptoms such as swelling and redness in the breast area during lactation.

Breast infection is the most common cause, but mastitis can be noninfectious too. It can occur when a milk duct becomes plugged. If left untreated, mastitis can lead to breast abscesses.

Mastitis can sometimes be mistaken for a breast abscess as well, so an ultrasound is needed to properly differentiate between the conditions.

A 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 have. This allows the healthcare professional to provide the best form of treatment for you. The doctor may need to know exactly what kind of bacteria are causing your infection since some bacteria are resistant to certain medications.

Blood tests may also be ordered to help the doctor look for infection and check your immune health.

An ultrasound of your breast may also be performed to determine what structures under the skin are being affected and how deep your abscess goes beneath your areola.

Occasionally, an MRI scan may be performed as well, especially for a severe or recurrent infection.

The first stage of treatment is taking antibiotics, usually for 10 to 14 days. Antibiotic regimens that may be prescribed include:

  • amoxicillin/clavulanate (Augmentin), a drug combination also known as co-amoxiclav
  • a combination of the antibiotics clarithromycin and metronidazole
  • a combination of the antibiotics erythromycin and metronidazole

Drainage

Depending on the size of the abscess and your level of discomfort, your doctor may also want to open 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 would be used to numb the area.

Surgery

If the infection doesn’t 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 performed in a doctor’s office, surgical outpatient center, or hospital, depending on the size and severity of the abscess.

Abscesses and infections can recur even after you’ve been treated with antibiotics. Surgery may be required to remove the affected glands to prevent recurrence.

Even if the infection is successfully treated with antibiotics, your nipple and areola can be deformed or pushed off center by the abscess, causing cosmetic damage. Nipple inversion can also take place. There are surgical solutions to these complications.

In most cases, nipple problems or abscesses don’t indicate breast cancer. However, it’s still important to contact your doctor if you think you may have a subareolar breast abscess.

Any infection in someone who isn’t breastfeeding has the potential to be a rare form of breast cancer. According to the American Cancer Society (ACS), inflammatory breast cancer can sometimes be mistaken for an infection.

Most breast abscesses are treated with antibiotics or by having the abscess drained. However, sometimes recurring or severe infections require surgery.

Most of the time, surgery is successful in preventing the abscess and infection from returning.

Since a subareolar breast abscess is the result of a bacterial infection, you’ll need antibiotics to reduce the presence of bacteria.

However, there are at-home treatments you can use that can help reduce pain and discomfort while the subareolar breast abscess is healing:

  • Keep the area clean. Wash your skin and the nipple with a gentle antibacterial soap. Allow the area to air-dry before putting on a bra or shirt.
  • Apply ice. Apply a cloth-covered ice pack to your affected breast for 10 to 15 minutes at a time, several times a day. This can reduce inflammation and swelling.
  • Apply cabbage leaves. This remedy is traditionally used to relieve mastitis. After cleaning cabbage leaves, place them in the refrigerator until they’re cooled. Remove the cabbage leaves’ base and place the leaf over your affected breast. The cool nature of the cabbage leaf can be soothing.
  • Wear a breast pad. Wear a soft breast pad in your bra to help drain pus and reduce any friction that could cause increased discomfort. Breast pads are available in the same store aisles as nursing products. They usually have a soft side and an opposite adhesive side to secure to your bra.
  • Take a pain reliever. Over-the-counter pain relievers, such as ibuprofen (Advil, Motrin) or acetaminophen (Tylenol), help reduce breast pain and discomfort.
  • Avoid disturbing the abscess. Refrain from squeezing, pushing, popping, or otherwise disturbing the abscess, as this can worsen symptoms.

Always contact your doctor if you have symptoms of a worsening infection, such as:

  • high fever
  • spreading redness
  • fatigue
  • malaise, much like you would feel if you had the flu

Means for preventing subareolar breast abscesses are currently limited.

Practicing good hygiene, keeping the nipple and areola very clean if you have a piercing, and not smoking can help.

Read this article in Spanish.