Breast Abscesses: Causes, Symptoms, & Treatment

Is your breast hot to the touch? Is it red, painful, or swollen? These may be the symptoms of a breast abscess. Breast pain caused by an abscess can feel like a shooting, stabbing, or dull pain that can happen in, under, and around one or both breasts.

It can be incredibly uncomfortable and you will want to find a way to relieve the pain as swiftly as possible. You might also be concerned about what is causing the pain and how serious a breast abscess is. Don’t worry—while breast abscesses are painful, they are not life-threatening. With the correct course of treatment, you should be feeling much better within a day or two!

What Is a Breast Abscess?

A breast abscess is a build-up of pus (a liquid comprised of dead white blood cells) due to a bacterial infection in the breast tissue.

If you have a breast abscess, the skin on your breast will look red and angry. Your breast may also be swollen and will likely feel hot to the touch.

The affected breast may also be tender and it might hurt to lie on your front or put pressure on it. In addition to bacterial breast abscesses, it is also important to know about other causes of breast infections.

What is mastitis?

Mastitis is an inflammation or infection of the breast tissue which commonly occurs in women who are breastfeeding.

While a breast abscess involves a discrete pocket of infected fluid, mastitis may be more widespread. If mastitis goes untreated, it can progress to a more severe infection, or it can cause an abscess.

Breast infections, such as mastitis and breast abscesses, occur most commonly in women aged between 15-45 years old, and often occur simultaneously.

What is a non-lactational breast abscess?

You can still get a breast abscess even if you are neither pregnant nor breastfeeding. This is called a non-lactational breast abscess. There are two types of non-lactational breast abscesses:

Peripheral breast abscess: Peripheral breast abscesses are those that occur away from the nipple and the nipple-areolar complex. They are usually similar to any other infection you might get and are treated with antibiotics.

Sometimes peripheral breast abscesses are caused by another underlying medical issue such as diabetes, a chronic skin condition such as hidradenitis (clogged sweat glands), acne, or trauma.

Areolar/subareolar breast abscess: Subareolar breast abscesses are infected lumps that occur just under, near, or behind the areola, nipple or nipple-areolar complex. If you are between the ages of 18-50 years, you are at the highest risk of developing this kind of abscess.

You are also at greater risk if you smoke, are obese, or if you have a nipple piercing. Subareolar and areolar breast abscesses are somewhat more common in African-Americans. One type of subareolar breast abscess is a lactiferous fistula, also known as Zuska’s disease, which is a rare recurrent condition characterized by abscesses around the nipple on one or both breasts.

Causes of a Breast Abscess

Breast abscesses are most often caused by a bacterial infection. Bacteria enter the breast through small cracks or breaks in the skin of the nipple. This usually occurs as a side effect of breastfeeding. However, abscesses can also be caused by any of the following:

Untreated mastitis: Untreated mastitis during breastfeeding is the most common cause of a breast abscess. Milk trapped in the breast causes mastitis which, if left untreated, develops into an abscess.

A blocked milk duct: If a breast doesn’t completely empty during breastfeeding, your milk ducts can become clogged. Milk then backs up in the ducts, leading to an infection.

Bacteria entering your breast: If you have a crack in the skin or a cut during breastfeeding, bacteria from your skin’s surface, or from your baby’s mouth, can enter your milk ducts. Stagnant milk in a breast that is not fully emptied provides a breeding ground for bacteria and subsequent infection.

Inflammatory breast cancer: Some types of breast cancer, most notably inflammatory breast cancer, may result in pain or inflammation similar to that of a breast abscess.

While not common, if you have other concerning symptoms such as bleeding from your nipples, retraction of the nipple (your nipple is pulled forwards), or no obvious reason to have a breast infection, it is important to be evaluated for cancer.

Breast Abscess Symptoms

If you have a breast abscess, you will feel uncomfortable and may be in considerable pain. Some common symptoms of a breast abscess include:

• A tender swelling or lump in one or both breasts
• Pain in one or both breasts
• Redness or warmth in one or both breasts
• Fever
• Muscle aches
• Feeling generally unwell

As discussed above, mastitis also causes inflammation of the breast tissue and similar symptoms to those of a breast abscess. Mastitis is most common in breastfeeding women (lactational mastitis), but it can also occur even if you are not breastfeeding. It can also rarely occur in men. Untreated mastitis can develop into a breast abscess, so it is important to consult a doctor at the first sign of infection.

The symptoms of mastitis are similar to those of an abscess:

• Breast tenderness or warmth to the touch
• Breast swelling
• Thickening of breast tissue, or a breast lump
• Burning or pain that can happen while breast-feeding or continuously
• Skin redness, often in a wedge-shaped pattern
• Generally feeling ill
• Fever of 101° F(38.3 C) or greater

Breast Abscess Diagnosis

If you suspect you have a breast abscess or another type of breast infection, consult with your doctor immediately. Prompt treatment will not only relieve your pain, but it can prevent your condition from developing into a more serious or widespread infection.

Your doctor will usually be able to diagnose a breast abscess or mastitis by means of a thorough history and physical exam.

To aid in making the correct diagnosis, your doctor might also order one or more of the following:

Ultrasound scan: A (painless) noninvasive ultrasound scan of your breast can confirm the diagnosis and establish the size and location of an abscess. Ultrasounds can also distinguish between a fluid-filled abscess and a solid mass, such as a tumor.

Bacterial culture and cytology: Your doctor may obtain a sample of your breast milk or of the abscess fluid and send it for further testing, including an examination of the cells (cytology) and a bacterial culture. This is to help identify the organism causing the infection to better guide antibiotic therapy, and to check for abnormal cells.

Mammogram with biopsy: If you are not breastfeeding or have not responded to previous attempts at treatment, your doctor may order a mammogram or breast biopsy. This measure may be taken if your doctor suspects breast cancer, which can cause symptoms similar to those of an abscess or mastitis.

How to Treat a Breast Abscess

In some cases, your abscess will require more direct medical intervention and your doctor might suggest any of the following treatments:

Antibiotics: The most common type of bacteria found in breast abscesses is staphylococcus aureus. Your doctor may prescribe you an antibiotic to treat this bacteria.

Aspiration during ultrasound: Breast abscesses can often be drained (aspirated) with a needle at the time of the ultrasound scan, and a sample of the drained fluid can be sent off to a lab to be tested for a bacterial infection or other problems.

Aspiration will often lead to decreased pain, pressure, and swelling. Sometimes, repeated aspirations are necessary as the fluid might build up again.

Surgery: Some abscesses are too large to be drained with a needle and they might have to be removed by making a small surgical cut (incision and drainage). In the case of a subareolar abscess, it is sometimes necessary to surgically remove a duct, sinus tract, or an area of inflamed tissue.

If your abscess is very small, it might not need to be drained and may resolve with conservative treatment. Stay comfortable until this happens by taking over-the-counter (OTC) pain relievers and non-steroidal anti-inflammatory medicine (NSAID), as well as performing some of the self-help measures described below.

What You Can Do at Home

Antibiotics should be your first course of treatment when it comes to breast abscesses but there are also at-home remedies you can incorporate that will help reduce breast pain and ease your symptoms:

Heating pads: In the case of mastitis, placing a heating pad or a warm washcloth on your breast for 15-30 minutes before breastfeeding has been proven to make nursing easier and reduce pain in your breasts by softening your breast tissue and loosening blocked milk ducts.

Cold therapy: In addition to heat, cold compresses are also helpful when it comes to reducing inflammation. While heat is great to use prior to breastfeeding, applying ice for 15-30 minutes after nursing can help reduce swelling.

Cabbage leaves: Placing cold cabbage leaves directly on your breasts or infected areas can help reduce swelling and ease any pain you may be feeling. Make sure the leaves are washed beforehand and keep them in the fridge so they stay cool. You can change them every hour as needed.

OTC medications: There are several OTC pain medications that will reduce your breast pain and are safe to take when breastfeeding. You can take acetaminophen (Tylenol) or ibuprofen (Advil, Motrin) as directed.

If you experience shooting or stabbing pains and OTC medications are not strong enough, a doctor may prescribe you a prescription strength pain reliever.

Frequent cleaning: It is important to keep the skin around the infection clean. This will help it heal. Use an antibacterial soap daily, particularly around the nipple area where bacterial infections are more likely to occur.

Regular feedings: In the case of mastitis, your instinct may be to stop breastfeeding. Although it may be painful to continue breastfeeding when you have an infection, frequent feedings will prevent engorgement, swelling, and clogged milk ducts, helping to relieve the mastitis.

Related Conditions and Risk Factors

You are at greater risk of getting a breast abscess if:

• You have an injury to the breast
• You have cracked nipples
• You have diabetes
• You have AIDS
• You have an impaired immune system
• You have pierced nipples
• You have had breast implant surgery
• You are a regular smoker (regular smokers are also more likely to develop recurrent abscesses)

Even if you are not breastfeeding, your chances of getting a breast abscess are higher if you have any of the following risk factors:

• You are African-American
• You are obese
• You smoke regularly

When to See a Doctor

Visit your doctor if you notice that your breast is red, painful, hot or swollen. Prompt treatment will give you relief as well as stop the infection from worsening.

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