- Breast abscess: localized accumulation of infected fluid within the breast parenchyma
- Mastitis: breast inflammation with or without infection. This can be associated with lactation (puerperal) or nonlactational.
- Associated with lactation or fistulous tracts secondary to squamous epithelial neoplasm or duct occlusion
- System(s) affected: skin/exocrine, immune
- Synonym(s): mammary abscess; peripheral breast abscess; subareolar abscess; puerperal abscess
Most commonly associated with postpartum lactation
- Most common benign breast problem during pregnancy and puerperal period (1)
- Predominantly reproductive age and perimenopausal (between ages 18 and 50)
- Predominant sex: female
- Higher incidence in African American, diabetic, smoking, or obese women (3)
- Ranges estimate up to 11% of breastfeeding women; the Academy of Breastfeeding Medicine cites 3% (2),(4).
- Puerperal abscess has highest incidence within 12 weeks postpartum (3) and while weaning from breastfeeding (4).
Transient condition; recurrences are most strongly associated with smoking, surgical treatment, and increased age (3).
Etiology and Pathophysiology
- Puerperal abscesses:
- Likely that bacteria (often from infants oral flora) gain entry through cracks/fissures in the nipple (1)
- Insufficient treatment of mastitis
- Unattended postpartum engorgement and other situations leading to breast milk stasis (4)
- Lactose-rich milk and plugged lactiferous duct causing stasis, leading to microbial growth and subsequent abscess formation
- Subareolar abscess:
- Staphylococcus aureus is most common cause for lactational abscesses (3),(4).
- Methicillin-resistant S. aureus (MRSA) is a significant cause (4).
- Less common causes (3)
- Streptococcus pyogenes, Escherichia coli, Bacteroides, Corynebacterium, Pseudomonas, Proteus
- Anaerobes and mixed flora are more common in subareolar abscesses.
- In patients with breast implants, coagulase negative S. aureus is more common.
- In nonlactational abscesses, lack of growth is a common result.
No current evidence to support a genetic predisposition to breast abscess formation (lifestyle/environment have been implicated more often)
- Maternal age >30 (5)
- Primiparous (5)
- Pregnancy ≥41 weeks’ gestation (5)
- Puerperal mastitis
- Up to 11% progression to abscess (3)
- Most often due to inadequate antibiotic and anti-inflammatory treatment of mastitis (4)
- Risk factors (stasis) (4):
- Infrequent or missed feeds
- Poor latch, weak or uncoordinated suckling
- Damage or irritation of the nipple
- Nipple inversion or retraction
- Inefficient removal of milk (by baby or pump)
- Oversupply of milk
- Illness in mother or baby
- Rapid weaning
- Plugged duct
- Pressure on the breast (i.e., tight bra, car seatbelt)
- Maternal stress and fatigue
- General risk factors (3)
- Smoking; diabetes; obesity
- African American
- Nipple piercing
- Medically related risk factors
- Breast implants
- Lumpectomy with radiation
- Inadequate antibiotics to treat mastitis
- Topical antifungal medication used for mastitis
- Frequent breast emptying with on-demand feeding and/or pumping to prevent mastitis
- Early treatment of mastitis with milk expression, antibiotics, and compresses
- Smoking cessation to minimize occurrence/recurrence
Commonly Associated Conditions
Lactation, mastitis, weaning
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Domino, Frank J., et al., editors. "Breast Abscess." 5-Minute Clinical Consult, 27th ed., Wolters Kluwer, 2020. Medicine Central, im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116088/all/Breast_Abscess.
Breast Abscess. In: Domino FJF, Baldor RAR, Golding JJ, et al, eds. 5-Minute Clinical Consult. Wolters Kluwer; 2020. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116088/all/Breast_Abscess. Accessed May 31, 2023.
Breast Abscess. (2020). In Domino, F. J., Baldor, R. A., Golding, J., & Stephens, M. B. (Eds.), 5-Minute Clinical Consult (27th ed.). Wolters Kluwer. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116088/all/Breast_Abscess
Breast Abscess [Internet]. In: Domino FJF, Baldor RAR, Golding JJ, Stephens MBM, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2020. [cited 2023 May 31]. Available from: https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116088/all/Breast_Abscess.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Breast Abscess ID - 116088 ED - Domino,Frank J, ED - Baldor,Robert A, ED - Golding,Jeremy, ED - Stephens,Mark B, BT - 5-Minute Clinical Consult, Updating UR - https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116088/all/Breast_Abscess PB - Wolters Kluwer ET - 27 DB - Medicine Central DP - Unbound Medicine ER -