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Key Features

  • Infection is generally caused by Staphylococcus aureus and is common in lactating women during nursing

  • Infection in nonlactating women is rare

  • However, subareolar abscesses may develop in nonlactating young or middle-aged women

  • In the nonlactating breast, consider inflammatory carcinoma

Clinical Findings

  • Redness, tenderness, and induration in the breast

Diagnosis

  • In lactating women, diagnosis is generally clinical

  • In nonlactating women, incision and biopsy of indurated breast tissue are indicated to rule out malignancy

  • Differential diagnosis

    • Breast cancer, especially inflammatory or Paget disease of the breast

    • Local irritation or trauma

    • Fat necrosis

    • Fibroadenoma

Treatment

  • Needle or catheter drainage is often adequate, but surgical incision and drainage may be necessary

  • An abscess tends to recur after aspiration unless area is explored during a quiescent interval with excision of the involved lactiferous duct or ducts at base of nipple

  • For abscess or cellulitis in nonlactating breast that does not promptly resolve with antibiotics, incision and biopsy of indurated tissue with small piece of erythematous skin are indicated

  • This biopsy is generally required to rule out malignancy (inflammatory breast cancer)

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