Breast Abscess

What is a breast abscess?

A breast abscess is a collection of infected fluid, or pus, within the breast that is generally painful, and may cause fever, chills, fatigue, and body aches.

A breast abscess is a complication of mastitis, an infection of the breast tissue, that develops most commonly in breastfeeding women. Mastitis and breast abscesses can occur in non-breastfeeding women, and even men, though this is less common.

A diagnosis of a breast abscess is usually made through physical examination, though physicians may choose to perform additional tests to evaluate the infection.

Breast abscesses are treated with antibiotics and by draining the pocket of fluid. It is generally recommended that nursing mothers with a breast abscess or mastitis continue to nurse throughout the infection.

You should visit your primary care physician to confirm the diagnosis and discuss treatment options. This can include a detailed history, physical exam, breast ultrasound, pain relievers, antibiotic therapy and a surgical consultation.

Breast abscess symptoms

Main symptoms

The symptoms of breast abscesses will likely include the following.

• Preceding breast pain, redness, swelling, and warmth: These breast abscess symptoms may be located near the nipple, near the sides of the breast, or throughout the breast. This may be due to a preceding mastitis or cellulitis that was not properly treated and thus led to the development of the breast abscess.
• Localized breast pain and tender fluctuant breastmass: Pain over the site of the abscess may occur, and a mass may be felt in the breast that is tender and painful to push on. The mass is "fluctuant," which means that it feels fluid-filled, and its presence is what distinguishes a breast abscess from mastitis or cellulitis, although it may not be felt in all cases. The painful breast mass will usually develop five to 28 days after the mastitis or cellulitis, although it may develop at the same time.
• Fever: Most people with a breast abscess will develop a fever and feel worse than usual overall. In rare cases, some may feel sick enough that they need to be monitored in the hospital.

Breast abscess causes

Breast abscesses usually develop from an infection of the breast tissue or of the skin overlying the breast that is not treated promptly or appropriately but can sometimes develop on their own without a preceding infection.

Breastfeeding

Women who are breastfeeding can develop an infection of the breast tissue, known as lactational mastitis. This usually occurs during the first three months of breastfeeding and can cause a painful, red, swollen breast with fever. If not treated promptly, the infection can progress to a breast abscess. Lactational mastitis is more likely to progress to a breast abscess in women older than 30 years of age, first-time mothers, and women who smoke.

Not breastfeeding

Men, as well as women who are not breastfeeding, can also develop inflammation or infection of the breast, known as non-lactational mastitis. This usually affects young women and can cause nipple pain and redness near the nipple or along the sides of the breast. These conditions can lead to the recurrent development of breast abscesses, especially if not treated appropriately.

Infection of the skin over the breast (breast cellulitis)

This may cause diffuse pain, warmth, and redness of the skin over the breast. This is more likely to occur after surgery or trauma to the breast, such as a cut, bug bite, piercing, or tattoos. This may also happen after radiation treatment to the breast for breast cancer. If the breast cellulitis is not promptly treated, it can develop into a breast abscess.

Treatment options and prevention for a breast abscess

Breast abscesses are usually treated with a combination of antibiotic medications to treat the infection and drainage of the infected fluid. Some other treatments may also be necessary.

Antibiotics

People who have a breast abscess should be given antibiotic medications to treat the infection. The specific antibiotic that the physician may recommend will vary based on the severity of the infection and the type of organisms that are causing the infection.

• Mild infections: These may be treated with oral antibiotics such as dicloxacillin, cephalexin (Keflex), clindamycin, or trimethoprim-sulfamethoxazole (Bactrim), among others.
• Severe infections: These may require treatment with an IV antibiotic such as vancomycin, piperacillin-tazobactam (Zosyn), or ceftriaxone (Rocephin).

Draining the infected fluid with a needle

The most important part of treating a breast abscess is to drain the infected fluid because antibiotic treatment alone is not enough to treat the infection. One way to drain the infected fluid is to remove it with a needle.

• Procedure details: Local anesthesia is administered to the skin, and a needle is inserted under imaging guidance to the location of the abscess to remove the infected fluid. Needle aspiration is usually repeated every two to three days until all fluid is drained. Usually, two or three aspirations are enough to remove the fluid.
• After the procedure: Antibiotics are usually continued for 10 to 14 days after the infected fluid is drained.

Treatment for some breast abscesses

The following treatments are recommended in some cases of breast abscesses.

• Surgery to drain the infected fluid: This may be recommended if the breast abscess is placing too much pressure on the overlying skin, or if it cannot be drained fully with needle aspiration, which may occur in about 40 percent of people [3]. Local anesthesia is administered to the skin, and then a small incision is made in the skin overlying the abscess to drain the infected fluid.
• Continued breastfeeding: If the breast abscess developed from breastfeeding, the physician may recommend that you continue breastfeeding, if possible. The breast abscess does not present any danger to the infant with breastfeeding, and breastfeeding can help drain the milk in the breast, which reduces the duration of breast abscess symptoms and improves the outcome.

When to seek further consultation for a breast abscess

You should go see your physician if you experience a warm, red, painful, swollen breast. He or she can perform an exam and determine if you have mastitis or cellulitis, and then recommend the appropriate treatment. Failure to treat mastitis or cellulitis promptly and appropriately can lead to the development of a breast abscess.

If you develop any symptoms of a breast abscess

You should go see your physician if you experience localized breast pain or a tender fluctuant mass in the breast. He or she can perform an exam and order imaging tests to determine if you have a breast abscess and then offer the appropriate treatment.