Overview

A breast abscess is a localized collection of pus within the breast tissue, usually resulting from a bacterial infection. It commonly occurs in women who are breastfeeding (lactational abscess) but can also affect non-lactating women and, rarely, men. A breast abscess typically presents as a painful, swollen lump accompanied by redness and warmth in the affected area. Without proper treatment, the infection can worsen, leading to increased pain, fever, and systemic illness. Early diagnosis and treatment are essential to relieve symptoms and prevent complications.

Causes

Breast abscesses are usually caused by bacterial infections that lead to pus formation. The most common contributing factors include:

• Bacterial infection: The most common bacteria involved is Staphylococcus aureus, including Methicillin-resistant Staphylococcus aureus (MRSA).
• Mastitis: An untreated or poorly managed breast infection (mastitis), especially in breastfeeding women, can progress to an abscess.
• Breastfeeding: Milk stasis, nipple cracks, or improper latching can allow bacteria to enter the breast tissue.
• Smoking: Non-lactational abscesses are more common in smokers due to damage to the ducts and tissue.
• Nipple piercings: Can introduce bacteria into breast tissue, increasing the risk of infection and abscess formation.
• Diabetes and immune suppression: Conditions that weaken the immune system may increase the risk of developing abscesses.
• Obesity: Higher rates of breast abscesses are observed in overweight individuals, particularly in non-lactating cases.

Symptoms

The symptoms of a breast abscess typically develop rapidly and include:

• Localized breast lump: A painful, firm, and swollen area in the breast that may feel warm to the touch.
• Redness: The skin over the affected area is often red and inflamed.
• Pain: Persistent and often severe pain localized to the site of the abscess, which may worsen over time.
• Fever and chills: Systemic symptoms may develop if the infection spreads.
• Pus discharge: In some cases, pus may drain spontaneously from the skin or nipple.
• Difficulty breastfeeding: Breastfeeding can become painful or difficult in cases of lactational abscesses.
• Swollen lymph nodes: Nearby lymph nodes, particularly in the armpit, may become enlarged and tender.

Diagnosis

Diagnosing a breast abscess involves clinical evaluation and imaging studies to confirm the presence of pus and rule out other breast conditions:

• Medical history and physical examination: A healthcare provider assesses symptoms, breastfeeding history, and examines the affected area.
• Ultrasound: Breast ultrasound is the preferred imaging method to differentiate between abscess and simple inflammation (mastitis) and to locate the abscess for drainage.
• Aspiration: Needle aspiration of the lump may be performed to confirm pus collection and obtain samples for bacterial culture.
• Blood tests: May be used to check for signs of infection, such as elevated white blood cell count or inflammatory markers.

Treatment

Effective treatment of breast abscesses focuses on relieving the infection, draining the abscess, and minimizing complications. Management options include:

• Antibiotics: Oral or intravenous antibiotics targeting the causative bacteria, especially Staphylococcus aureus. MRSA coverage may be needed based on risk factors or culture results.
• Abscess drainage:
  • Needle aspiration: Performed under ultrasound guidance for small or moderate-sized abscesses.
  • Surgical incision and drainage: Required for larger or complicated abscesses, especially when aspiration fails.
• Pain management: Analgesics such as acetaminophen or ibuprofen to relieve pain and reduce fever.
• Breastfeeding continuation: In lactating women, breastfeeding can often be continued on the unaffected breast, and sometimes even on the affected side after proper treatment.
• Follow-up care: Regular follow-up is necessary to ensure resolution of the abscess and prevent recurrence.

Prognosis

The prognosis for breast abscess is generally very good with timely diagnosis and treatment:

• Full recovery: Most patients recover completely without long-term complications when properly treated.
• Low recurrence in lactating women: With effective drainage and proper breastfeeding techniques, recurrence is uncommon.
• Higher recurrence in non-lactating cases: Non-lactational abscesses, especially in smokers, may have higher recurrence rates and require longer treatment.
• Minimal scarring: Proper drainage techniques can minimize cosmetic concerns, although minor scarring may occur.
• Complications: Untreated abscesses can lead to skin ulceration, fistula formation, or systemic infection, highlighting the importance of prompt treatment.

With appropriate medical care, most individuals with breast abscesses experience full resolution of symptoms and return to normal breast function.