Breast Abscess
Basics
Description
- 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
Pregnancy Considerations
Most commonly associated with postpartum lactation
Epidemiology
- Most common benign breast problem during pregnancy and puerperal period (1)
- Predominantly reproductive age and perimenopausal (between ages 18 and 50 years)
- Predominant sex: female
- Higher incidence in African American, diabetic, tobacco use, or obese women
Incidence
Ranges between 3% and 11% of women with mastitis (1),(3)
Prevalence
Transient condition usually as a complication of mastitis; mastitis prevalence ranges between 1% and 10% (1).
Etiology and Pathophysiology
- Puerperal abscesses:
- Associated with hyperlactation and dysbiosis (disrupted milk microbiome); these can lead to ductal narrowing and inflammation and subsequently to reduced milk flow, obstruction, plugged lactiferous duct causing stasis, microbial growth, and infection (3).
- Mammary dysbiosis is a consequence of multiple factors including genetic, breastfeeding-related, medical, and microbial (3).
- 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 (3)
- Subareolar abscess:
- Associated with squamous metaplasia of the lactiferous duct epithelium, keratin plugs, ductal ectasia, and fistula formation (2)
- Microbiology
- Staphylococcus aureus is the most common cause of lactational abscesses (1),(2).
- Methicillin-resistant S. aureus (MRSA) is a significant cause (1).
- Other common causes include coagulase-negative staphylococci and Streptococcus spp. (2),(3).
- Less common causes (1):
- Escherichia coli, Enterobacteriaceae, Corynebacterium, and Pseudomonas
- Anaerobes
- May be polymicrobial
Genetics
Maternal genetics may play a role as protective and predisposing factors for mammary dysbiosis, which is associated with the pathophysiology (3).
Risk Factors
- Smoking, maternal age >30 years
- Primiparous, pregnancy ≥41 weeks’ gestation
- Diabetes and obesity
- African American
- Nipple piercing
- Milk stasis:
- 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
- Medically related risk factors
- Steroids
- Breast implants
- Lumpectomy with radiation
- Inadequate antibiotics to treat mastitis
- Topical antifungal medication used for mastitis
General Prevention
- 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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Citation
Domino, Frank J., et al., editors. "Breast Abscess." 5-Minute Clinical Consult, 33rd ed., Wolters Kluwer, 2025. 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; 2025. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116088/all/Breast_Abscess. Accessed November 5, 2024.
Breast Abscess. (2025). In Domino, F. J., Baldor, R. A., Golding, J., & Stephens, M. B. (Eds.), 5-Minute Clinical Consult (33rd 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; 2025. [cited 2024 November 05]. Available from: https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116088/all/Breast_Abscess.
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