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'.)
- Dener C, Inan A. Breast abscesses in lactating women. World J Surg 2003; 27:130.
- Amir LH, Forster D, McLachlan H, Lumley J. Incidence of breast abscess in lactating women: report from an Australian cohort. BJOG 2004; 111:1378.
- Dixon JM, Khan LR. Treatment of breast infection. BMJ 2011; 342:d396.
- Bharat A, Gao F, Aft RL, et al. Predictors of primary breast abscesses and recurrence. World J Surg 2009; 33:2582.
- Berens PD. Prenatal, intrapartum, and postpartum support of the lactating mother. Pediatr Clin North Am 2001; 48:365.
- Kvist LJ, Rydhstroem H. Factors related to breast abscess after delivery: a population-based study. BJOG 2005; 112:1070.
- Gollapalli V, Liao J, Dudakovic A, et al. Risk factors for development and recurrence of primary breast abscesses. J Am Coll Surg 2010; 211:41.
- Dixon JM. Breast abscess. Br J Hosp Med (Lond) 2007; 68:315.
- Dixon JM. Breast infection. In: ABC of Breast Diseases, Dixon JM (Ed), Blackwell Publishing, Oxford 2006. p.19.
- Ozseker B, Ozcan UA, Rasa K, Cizmeli OM. Treatment of breast abscesses with ultrasound-guided aspiration and irrigation in the emergency setting. Emerg Radiol 2008; 15:105.
- Department of child and adolescent health and development. Mastitis: Causes and management. World Health Organization 2000. http://whqlibdoc.who.int/hq/2000/WHO_FCH_CAH_00.13.pdf (Accessed on August 17, 2009).
- Spencer JP. Management of mastitis in breastfeeding women. Am Fam Physician 2008; 78:727.
- Leach RD, Eykyn SJ, Phillips I, Corrin B. Anaerobic subareolar breast abscess. Lancet 1979; 1:35.
- Dixon JM, Bundred NJ. Management of disorders of the ductal system and infections. In: Diseases of the Breast, Harris JR, Lippman ME, Morrow M, Osborne CK (Eds), Lippincott Williams & Wilkins, Philadelphia 2004. p.47.
- Hughes LE, Mansel RE, Webster DJT. Miscellaneous conditions. In: Benign Disorders and Diseases of the Breast: Current Concepts and Clinical Management, Hughes LE, Mansel RE, Webster DJT (Eds), Edward Arnold, London 2000. p.231.
- Dixon JM. Repeated aspiration of breast abscesses in lactating women. BMJ 1988; 297:1517.
- Schwarz RJ, Shrestha R. Needle aspiration of breast abscesses. Am J Surg 2001; 182:117.
- Eryilmaz R, Sahin M, Hakan Tekelioglu M, Daldal E. Management of lactational breast abscesses. Breast 2005; 14:375.
- Karstrup S, Solvig J, Nolsøe CP, et al. Acute puerperal breast abscesses: US-guided drainage. Radiology 1993; 188:807.
- O'Hara RJ, Dexter SP, Fox JN. Conservative management of infective mastitis and breast abscesses after ultrasonographic assessment. Br J Surg 1996; 83:1413.
- Christensen AF, Al-Suliman N, Nielsen KR, et al. Ultrasound-guided drainage of breast abscesses: results in 151 patients. Br J Radiol 2005; 78:186.
- Berna-Serna JD, Madrigal M, Berna-Serna JD. Percutaneous management of breast abscesses. An experience of 39 cases. Ultrasound Med Biol 2004; 30:1.
- Department of child and adolescent healtlh and development. Mastitis: Causes and management. World Health Organization 2000; http://whqlibdoc.who.int/hq/2000/WHO_FCH_CAH_00.13.pdf (Accessed August 17, 2009).
- Thomsen AC, Espersen T, Maigaard S. Course and treatment of milk stasis, noninfectious inflammation of the breast, and infectious mastitis in nursing women. Am J Obstet Gynecol 1984; 149:492.
- Rizzo M, Peng L, Frisch A, et al. Breast abscesses in nonlactating women with diabetes: clinical features and outcome. Am J Med Sci 2009; 338:123.
- ATKINS HJ. Mammillary fistula. Br Med J 1955; 2:1473.
- Dixon JM, Ravisekar O, Chetty U, Anderson TJ. Periductal mastitis and duct ectasia: different conditions with different aetiologies. Br J Surg 1996; 83:820.
- Barker P. Milk fistula: an unusual complication of breast biopsy. J R Coll Surg Edinb 1988; 33:106.
- Schackmuth EM, Harlow CL, Norton LW. Milk fistula: a complication after core breast biopsy. AJR Am J Roentgenol 1993; 161:961.