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Updated 13 February 2013

Breast abscess

A breast abscess is an accumulation of pus in the breast tissue. This is usually preceded by infection of the breast (mastitis).

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Summary

  • Breast abscess is an accumulation of pus in the breast tissue.
  • Breast infections are usually caused by common bacteria.
  • Infections occur almost exclusively in breast-feeding mothers.

Description

A breast abscess is an accumulation of pus in the breast tissue. This is usually preceded by infection of the breast (mastitis). Trauma (injury) and infection in the breast produce symptoms typical of infection anywhere else in the body, except that in the breast, infections tend to become walled off from surrounding tissue, producing small abscesses. These may resemble cysts.

Cause

Breast infections are usually caused by common bacteria found on normal skin (Staphylococcus aureus). Infections occur almost exclusively in breastfeeding mothers. The bacteria enter through a break in the skin, usually a cracked nipple during the early days of breastfeeding. The infected area becomes filled with pus.

Breast infections not related to breastfeeding must be differentiated from breast cancer. Rarely, young to middle-aged women who are not breastfeeding develop subareolar abscesses (located beneath the areola, the darker area around the nipple). This condition virtually exclusively occurs in smokers.

Potential abscesses in breast tissue other than the subareolar area are extremely rare in women not breastfeeding and should be surgically removed or biopsied.

Symptoms

  • Breast pain, tenderness, redness or hardness, swelling, a sensation of heat in the affected area
  • Fever and chills
  • A general ill feeling
  • Tender lymph nodes under armpits

Risk factors

The following factors may be associated with breast abscess:

  • Postpartum (after giving birth) pelvic infection
  • Fatigue
  • Anaemia
  • Diabetes mellitus
  • Use of steroid medications
  • Low immunity states
  • Heavy cigarette smoking
  • Silicone implants

Diagnosis

In women who are breastfeeding, the diagnosis is fairly simple. It is complicated in women not breastfeeding by the possibility that the symptoms are also produced by breast cancer. Thus, in non-lactating women, a needle biopsy may be necessary to rule out the possibility of cancer.

Treatment

Home

  • Warm water soaks or warm compresses may relieve discomfort and encourage healing. (Sometimes, cold soaks or compresses may be preferred).
  • Breastfeeding from an infected breast should not be discontinued if the mother is able to continue.
  • Feeding of the baby should be continued on the other side to prevent the formation of a further abscess in the non-infected breast.
  • A breast pump should be used to express milk regularly from the infected breast if nursing cannot be resumed on that side.

Medication

  • Antibiotics to destroy the bacteria which cause the infection. (While breastfeeding, treatment with antibiotics is usually continued for seven days.)
  • Nonsteroidal anti-inflammatory drugs
  • Pain alleviation

After treatment, normal activity can be resumed as soon as symptoms have improved.

Surgery

Once pus accumulates (breast abscess), this must be drained either by percutaneous needle aspiration if the collection is small, or by surgical incision. An antibiotic must be used in the mastitis and/or abscess phase.

Non-lactating breast abscess – especially in smokers – is usually due to an abnormality in the milk ducts and requires removal of the affected ducts.

Prevention

  • Some mothers have flat or retracted nipples which makes breastfeeding difficult or impossible. To improve this, Hoffman's exercises can be started from 32 weeks of pregnancy.

    A little lubricant (e.g. Vaseline) is applied over the areola. Both index fingers or one index finger and the thumb are placed alongside the nipple and the skin is gently pulled away from the nipple in a horizontal direction. Thereafter, this action is repeated in a vertical direction, followed by a repetition of both actions several times. If these exercises are done several times per day, it will help to lift out the nipple.

    An alternative method, which helps to lift out retracted nipples, is the wearing of special breast shields inside the bra during pregnancy.

  • Nipples and breasts should be thoroughly cleaned before and after breastfeeding.
  • After breastfeeding, nipples may be lubricated with lanolin or Vitamin A & D ointment.
  • Clothing which irritates the breasts should be avoided.
  • Nursing mothers should not allow their babies to chew the nipples.
  • If a mother wants to stop breastfeeding, lactation can be suppressed with fluid restriction and bromocriptine (Parlodel®).
  • Continuation of breastfeeding is not advised in women in whom suppression of lactation has failed.

Reviewed by Dr Jenny Edge, General Surgeon, BSc, MB BS, FRCS (Edin), M Med (Stell), September 2004

Read more:
ABC of breastfeeding
Debate on whether breast is best
Who gets recurrent breast abscess?

 
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