Breast Abscess

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 incision and drainage unless the 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)