Breast abscess

Last updated: November 21, 2022

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A breast abscess is an encapsulated accumulation of pus within the breast tissue that most commonly results from puerperal mastitis. Nonpuerperal abscesses are uncommon and may be caused by trauma. Breast abscesses typically manifest as a tender, erythematous breast mass with or without systemic signs of infection, such as fever. The diagnosis is primarily clinical, but imaging and aspiration are often required for confirmation and to guide management. Treatment involves drainage, antibiotics, and analgesia.

A fluctuant breast mass may indicate an abscess.

Although abscess is often diagnosed clinically, imaging and aspiration are used to confirm the diagnosis and guide management. [3][5]

Breast ultrasound [2][3]

Mammography [2]

  • Indications
    • Nonpuerperal abscesses (after the acute phase) [2][4]
    • Prolonged symptoms in a lactating woman
  • Findings: asymmetrical mass or architectural distortion with skin thickening

Fine needle aspiration

  • Can be diagnostic and therapeutic [3][5]
  • Aspiration of purulent fluid confirms the diagnosis. [4]
  • Aspirate should be sent for cultures.

Treatment typically involves drainage, antibiotics, and adequate pain management. Surgical excision may be considered for chronic abscesses or fistulas. [1][3][4]

Abscess drainage [7]

Antibiotic treatment [3][4]

Patients with puerperal abscesses can continue to breastfeed. Patients who have undergone an incision and drainage may consider using a breast pump. [1][4]

  1. Spencer JP. Management of mastitis in breastfeeding women. Am Fam Physician. 2008; 78 (6): p.727-731.
  2. Trop I, Dugas A, David J, et al. Breast Abscesses: Evidence-based Algorithms for Diagnosis, Management, and Follow-up. RadioGraphics. 2011; 31 (6): p.1683-1699. doi: 10.1148/rg.316115521 . | Open in Read by QxMD
  3. ACOG. Practice Bulletin No. 164 Diagnosis and management of benign breast disorders. Obstetrics & Gynecology. 2016; 127 (6): p.e141-e156. doi: 10.1097/aog.0000000000001482 . | Open in Read by QxMD
  4. Boakes E, Woods A, et al. Breast Infection: A Review of Diagnosis and Management Practices. Eur J Breast Health. 2018 . doi: 10.5152/ejbh.2018.3871 . | Open in Read by QxMD
  5. Mitchell KB, Johnson HM, Rodríguez JM, et al. Academy of Breastfeeding Medicine Clinical Protocol #36: The Mastitis Spectrum, Revised 2022. Breastfeed Med. 2022; 17 (5): p.360-376. doi: 10.1089/bfm.2022.29207.kbm . | Open in Read by QxMD
  6. Cho SH, Park SH. Mimickers of Breast Malignancy on Breast Sonography. Journal Ultrasound Med. 2013; 32 (11): p.2029-2036. doi: 10.7863/ultra.32.11.2029 . | Open in Read by QxMD
  7. Kasales CJ, Han B, Smith JS, Chetlen AL, Kaneda HJ, Shereef S. Nonpuerperal Mastitis and Subareolar Abscess of the Breast. AJR Am J Roentgenol. 2014; 202 (2): p.W133-W139. doi: 10.2214/ajr.13.10551 . | Open in Read by QxMD
  8. Rao R, Ludwig K, Bailey L, et al. Select Choices in Benign Breast Disease: An Initiative of the American Society of Breast Surgeons for the American Board of Internal Medicine Choosing Wisely® Campaign. Ann Surg Oncol. 2018; 25 (10): p.2795-2800. doi: 10.1245/s10434-018-6584-5 . | Open in Read by QxMD

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