What is Breast Abscess?
Breast infections can be split into two types: those linked to breastfeeding (lactational) and those that are not (non-lactational). They may involve the skin’s surface or deeper tissues. More often, breast abscesses, which are pockets of pus, appear in women who are breastfeeding, though they can also happen in women who aren’t. If a woman with a non-lactating breast abscess shows up with certain signs and symptoms, it’s crucial to check for more serious conditions like breast cancer. Though these infections mainly affect women, men can get them too. Diagnosing and treating breast abscesses is usually straightforward, but they are known to return frequently.
What Causes Breast Abscess?
Breast abscesses that occur during breastfeeding are most often due to bacteria such as Staphylococcus aureus and Streptococcal species. A type of Staphylococcus aureus that is resistant to methicillin, a common antibiotic, is becoming more common. On the other hand, breast abscesses that aren’t related to breastfeeding typically result from a mix of different bacteria, including Staphylococcus aureus, Streptococcus, and anaerobic bacteria (ones that don’t need oxygen).
Risk Factors and Frequency for Breast Abscess
Breast infections are often linked with lactation, affecting 10% to 33% of breastfeeding women. A specific type of breast infection called lactational mastitis affects 2% to 3% of lactating women, and of these, between 5% and 11% may develop an abscess. This condition is most prevalent among women of childbearing age, on average around 32 years old.
Moving on to women who aren’t breastfeeding, breast abscesses show up across a wider age range, peaking in a woman’s 40s. Factors like diabetes, smoking, obesity, and being African American can increase the risk of developing non-lactational breast abscesses. Interestingly, nipple piercings have also been tied to subareolar breast abscesses in non-breastfeeding women.
- 10%-33% of breastfeeding women experience breast infections.
- Lactational mastitis affects 2%-3% of lactating women.
- 5%-11% of women with lactational mastitis may develop an abscess.
- The average age of women with this condition is around 32.
- For non-breastfeeding women, breast abscesses are most common in their 40s.
- Diabetes, smoking, obesity, and being African American increase the risk of non-lactational breast abscesses.
- Nipple piercings can also increase the risk of subareolar breast abscesses in non-breastfeeding women.
Signs and Symptoms of Breast Abscess
Mastitis, a breast infection, often presents with symptoms such as breast pain, redness, warmth, and possibly swelling. Some women may have a history of breastfeeding. It’s essential to know if they’ve had any previous breast infections and how those were treated. Other common complaints can include fever, nausea, vomiting, pus draining from the nipple, or from the site of redness. It’s also important to know about any existing medical conditions like diabetes. Most cases of post-birth mastitis are observed within six weeks of breastfeeding.
Physical examination usually reveals redness, hardness, warmth, and tenderness at the affected site. It might feel like there is a noticeable lump or an area of fluctuation. There could be pus discharge at the nipple or the fluctuating site. The patient may have swollen lymph nodes in the armpit. Not as common, but the patient might have fever or a rapid heart rate detected during the exam.
Testing for Breast Abscess
The main way to diagnose a breast abscess is through a physical exam. Your doctor might also take a blood sample to check for a high white blood cell count, but this isn’t always necessary. If there’s any visible discharge, the doctor can take a sample to identify the best antibiotic to treat it. A breast ultrasound can sometimes be used to determine whether the infection is in the skin tissues (cellulitis) or if it has formed an abscess, which is a pocket of pus that might need draining.
On the ultrasound, abscesses may look like undefined masses with walls inside them. In some situations, to make sure an abscess is present, a needle can be used to draw out some fluid to be tested.
Treatment Options for Breast Abscess
The standard treatment for breast abscesses is a procedure called incision and drainage. If you see a healthcare provider who isn’t comfortable with carrying out this procedure, you might be given antibiotics and then sent on to a general surgeon for further treatment. Smaller abscesses, or those that occur because a woman is breastfeeding, can sometimes be treated with a less invasive procedure called needle aspiration.
If an abscess comes back after a needle aspiration, or if the abscess is not linked to breastfeeding (these have a higher chance of coming back), then the doctor might need to perform an incision and drainage, which involves opening up the abscess and draining the pus. Even though this procedure is more comprehensive and therefore less likely to lead to a recurrence, it is more invasive, which means it might leave a scar and affect the appearance of the breast. To promote more effective drainage and stop the skin from healing too quickly, your healthcare provider may pack the incision with a special dressing. If an abscess is caused by a blocked or widened milk duct, surgical removal of the duct might be necessary.
Antibiotics may be given either before or after the abscess is drained. There are various types of antibiotics suitable for different patients and situations, so your doctor will select the best one based on factors such as your medical history, whether you are breastfeeding, and the kind of bacteria causing the infection. If you have repeat infections, your doctor may take a sample from your abscess to help identify the most effective antibiotics. A course of antibiotics typically lasts for four to seven days.
If you have a particularly large abscess or signs of widespread infection, known as sepsis, you might need to be admitted to the hospital. Large abscesses might require surgical drainage in an operation room, which might include packing the wound to facilitate healing, and possibly intravenous antibiotics. Pain relief options might include over-the-counter anti-inflammatory drugs like ibuprofen or prescription painkillers.
If you are breastfeeding and have been diagnosed with a breast abscess, you should stop feeding your baby from the affected breast to prevent spreading the infection to your child.
What else can Breast Abscess be?
It’s possible that a lump in the breast could be due to a variety of conditions, some of which are serious and others that are not. These could range from harmless cysts (also known as benign breast masses) to malignant (cancerous) growths. One type of malignant growth is called inflammatory breast cancer. Another possibility is an infection of the skin and tissues around the breast, known as cellulitis.
What to expect with Breast Abscess
Most isolated instances of breast abscess have positive outcomes. However, recurring infections can lead to discomfort, scarring, and a reduced quality of life for women.
In general, patients tend to recover within 2 to 3 weeks following mastitis. However, should symptoms of mastitis persist beyond 5 weeks, it’s crucial that the individual is examined for possible malignancy or infection.
Breast abscesses are more common in the period following childbirth. If seen in a woman who is not breastfeeding, it becomes important for the healthcare provider to eliminate the possibilities of inflammatory breast cancer, newly onset diabetes, or a specific kind of infection caused by a bacterium called mycobacterium.
Possible Complications When Diagnosed with Breast Abscess
After certain medical procedures, one might experience several side effects such as:
- Scarring
- Disparity in breast size or shape
- Pain
- Fistula, which is an abnormal connection between organs or vessels
- Retraction of the nipple-areola complex, leading to changes in appearance of the breast
Recovery from Breast Abscess
Once the breast abscess has been emptied, the pain should lessen rapidly. However, certain patients may require non-steroidal anti-inflammatory drugs (NSAIDs) to manage the pain. Using a warm compress can help calm the inflammation, and applying moisturizer can help prevent the nipples from cracking.
Preventing Breast Abscess
It’s important to teach the patient about proper cleanliness for their nipples and hands. They should also take steps to stop their breasts from becoming overly full and swollen. This guidance helps maintain health and comfort for the patient.
