Primary breast abscess
- J Michael Dixon, MD
J Michael Dixon, MD
- Professor of Surgery and Consultant Surgeon
- Edinburgh University
- Section Editors
- Anees B Chagpar, MD, MSc, MA, MPH, MBA, FACS, FRCS(C)
Anees B Chagpar, MD, MSc, MA, MPH, MBA, FACS, FRCS(C)
- Section Editor — Breast Surgery
- Associate Professor, Department of Surgery
- Yale University School of Medicine
- Daniel J Sexton, MD
Daniel J Sexton, MD
- Editor-in-Chief — Infectious Diseases
- Section Editor — Bacterial Infections
- Professor of Medicine
- Duke University Medical Center
A breast abscess is a localized collection of pus in the breast tissue. Primary breast abscesses develop when mastitis or cellulitis does not respond to antibiotic treatment. It is an uncommon problem in breastfeeding with a reported incidence of 0.1 percent ; the incidence among women with antibiotic-treated mastitis is 3 percent .
Issues related to primary breast abscess will be reviewed here. Issues related to mastitis, cellulitis, and postoperative complications of breast surgery are discussed separately. (See "Lactational mastitis" and "Nonlactational mastitis" and "Breast cellulitis and other skin disorders of the breast" and "Mastectomy: Indications, types, and concurrent axillary lymph node management", section on 'Complications' and "Breast conserving therapy", section on 'Postoperative Complications'.)
Primary breast abscesses develop as a complication of mastitis . In a review of 89 patients with primary breast abscesses requiring surgical intervention, 14 percent were complications of lactational mastitis and 86 percent were complications of nonlactational mastitis . Breast abscesses occurred more commonly in African Americans, obese patients, and smokers.
Risk factors for development of breast abscess as a complication of lactational mastitis include maternal age >30 years, first pregnancy, gestational age ≥41 weeks, and tobacco use [1,5,6]. In a retrospective study of 68 patients with a diagnosis of breast abscess, smoking was a significant risk factor for the development of an abscess (odds ratio 8.0, 95% CI 3.4-19.4) . Of the 68 cases, over half (54 percent) needed multiple surgical treatments and 22 of these were heavy smokers. Five patients developed fistulas and all were heavy smokers. In another retrospective study of 89 patients with a breast abscess, 39 women (43 percent) were heavy smokers . The majority of patients who developed recurrent abscesses were smokers (77 percent). Smoking was the only factor significantly associated with abscess recurrence.
Nonlactational abscesses may be classified as central, peripheral, or skin associated (figure 1). Central abscesses are usually due to periductal mastitis. Peripheral abscesses are less common than central abscesses and are sometimes associated with underlying disease states such as diabetes, rheumatoid arthritis, steroid treatment, and trauma. (See "Nonlactational mastitis", section on 'Periductal mastitis'.)
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