Breast abscess is an acute inflammatory process resulting in the formation of a collection of pus. Typically there is painful erythematous mass formation in the breast, occasionally with draining through the overlying skin or nipple duct opening.

Subareolar abscess
Lactational or puerperal abscess

• 10% to 30% of all breast abscesses are lactational.
• Acute mastitis occurs in 2.5% of nursing mothers, with 1 in 15 of these women developing abscess.

Painful erythematous induration involving the part of the breast leading to fluctuant abscess

• Lactational abscess: milk stasis and bacterial infection leading to mastitis, then to abscess, with Staphylococcus aureus the most common causative agent
• Subareolar abscess:

1.Central ducts involved, with obstructive nipple duct changes leading to bacterial infection
2.Cultured organisms mixed, including anerobes, staphylococci, streptococci, and others

• Inflammatory carcinoma
• Advanced carcinoma with erythema, edema, and/or ulceration
• Rarely, tuberculous abscess
• Hydradenitis of breast skin
• Sebaceous cyst with infection

• Clinical examination sufficient
• If abscess suspected, referral to surgeon for incision, drainage, and biopsy
• If possible abscess or advanced carcinoma, referral for workup required

• Perform C&S test of abscess contents.
• If mammogram or ultrasound prevented by discomfort, perform after resolution of abscess if required.

• Established abscess: incision and drainage, preferably with general anesthesia
• Biopsy of abscess cavity wall to exclude carcinoma

• Antibiotics: the pathogen is generally staphylococci in lactational abscess. Recommended initial antibiotic therapy is with nafcillin or oxacillin 2g q4h IV or cefazolin 1g q8h IV.
• If acute mastitis is treated early, resolution without drainage is possible.
• Subareolar abscess: broad-spectrum antibiotic treatment and drainage are needed to control acute phase.

Further surgical treatment for recurrences or fistula

• Lactational abscess: possible to continue breast-feeding without apparent risk of infection to the infant
• Subareolar abscess:

1.Notorious for recurrence or complication of fistula formation
2.Patient informed and referred for subsequent care

• If abscess drainage required
• For surgical consultation if subareolar abscess involved

Schwarz RJ, Shrestha R: Needle aspiration of breast abscesses, Am J Surg 182(2):117, 2001.