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Breast abscess: Causes, prevention, and treatment.

breast abscess: Woman touching her chest

Key takeaways:

  • Breast abscesses most often occur in breastfeeding women, but anyone can develop one.
  • A breast abscess is a painful, puss-filled mass or lump in your breast tissue.
  • Breastfeeding women can take steps to help mitigate the chances of getting a breast abscess.
  • A breast abscess or mastitis is not breast cancer, nor is it a precursor to cancer. 

If you’re experiencing pain and redness in a localized area on your breast or nipple, it may be a breast abscess.

While it can be unnerving to discover a painful lump in your breast, it’s important to remain calm. Still, please don’t ignore it. Make an appointment as soon as possible to see your healthcare provider.

A breast abscess is a pus-filled lump in your breast tissue that is caused by an infection. Though breast abscesses most commonly occur in breastfeeding women, anyone, regardless of gender, can develop one.

Other terms for “breast abscess” may include:

  • Breast infection
  • Primary breast abscess
  • Areolar breast abscess
  • Subareolar breast abscess
  • Areolar gland abscess

What is a breast abscess?

A breast abscess is a benign lesion or a mass in the breast tissue or under the breast’s skin. It is typically painful and filled with pus. Breast abscesses are often a complication of mastitis, an infection of the mammary glands’ tissue.

Your entire breast may be swollen and painful. Or, the infection may be localized to one area of your breast, your areola (the pigmented skin surrounding your nipple), or your nipple. The painful area may be red or even dark purple and bruised. 

Breast infections, including mastitis (or infectious mastitis) and breast abscesses, are most often seen in women aged 15 to 45.

What causes a breast abscess?

Breast abscesses are most common among lactating women. Lactational mastitis occurs in 2-3% of lactating women, and 5-11% of these women may develop one or more abscesses.

However, breast abscesses are not unique to women—anyone can get them. Abscesses not caused by lactation typically develop in people who are obese or are smokers

Other risk factors for breast abscess may include:

  • Nipple piercings
  • Breast implant surgery
  • Breast injury
  • Clogged milk ducts
  • Cracked nipples that allow bacteria to enter
  • Diabetes 
  • Compromised immune system

Lactational breast abscesses typically occur because of an infection with Staphylococcus aureus and Streptococcal bacteria.

When lactation is not the case, a breast abscess results from a composition of S. aureus, streptococcal, and anaerobic bacteria. These bacteria do not grow where oxygen is present—instead, they develop in places such as the gut.

Breastfeeding: A leading cause of mastitis. 

breast abscess: Mother holding her newborn child while breastfeeding

Breastfeeding your new baby can be a joyful time. Still, it can come with some discomfort if you don’t take care of yourself.

Among the most common causes of breast pain and abscess in breastfeeding mothers is mastitis and plugged milk ducts. 

Sore nipples and engorgement are part of being new to breastfeeding a newborn. Still, you can take steps to gain relief and prevent a more severe condition like cracked nipples or engorgement that leads to a breast abscess.

When your milk first comes in, your breasts will become engorged. The engorgement will subside within 12-48 hours with a bit of help from you and your baby together. 

  • You can use a warm, wet towel along with a gentle massage to help your milk let down. 
  • Your baby can do their part by nursing.

If your nipples become dry and cracked, take steps to heal them. Cracked nipples can invite bacteria and possibly cause an infection. 

To ease breastfeeding discomfort, take a few steps before feeding your baby:

  • Sit down to nurse when your baby starts showing early feeding cues—before they start crying.
  • Gently massage your breasts and apply warmth with a warm, wet washcloth to help get your milk flowing.
  • Using your thumb and forefinger, express a small amount of milk to soften and lubricate the areola and nipple.

During feeding:

  • Offer the least sore breast to your baby first.
  • Position your body correctly and attach your baby to your breast. If you’re unsure about positioning and attachment, ask a trusted friend or relative, or contact your local chapter of La Leche League
  • With each feeding, alternate the breast you offer first to your baby. Allow them to nurse until the first breast is empty. 
  • Break the baby’s suction with a clean finger inserted in the corner of their mouth before removing them from the breast.
  • You might need to take your baby off the sore breast for 12–24 hours to rest the nipple and allow healing to begin. In this case, you can express milk to maintain your supply and bottle-feed your baby with expressed breast milk to keep your breasts feeling comfortable.

After you feed your baby:

  • Look for signs of stress in your nipples—this could be red lines or a smashed appearance. 
  • Squeeze a few drops of milk onto your finger and gently smooth it over your nipple.
  • Apply lanolin cream to your nipples and areola to prevent them from cracking. If you want something more natural, try coconut oil. Coconut oil has antifungal properties and can help moisturize your skin.
  • If you usually use soap or shower gel when bathing, you can use this to clean your breasts and nipples as well. If your nipples are cracked, this may help to prevent infection.
  • After your baby’s feeding, allow your breasts to dry naturally in the air.

Things to avoid when breastfeeding:

  • Anything drying or damaging to your nipples, such as alcohol-based products, rough towels, or plastic-backed nursing pads. 
  • Nipple shields that are made of plastic and don’t allow air to get to your nipples. 
  • A breast pump with powerful suction—this may hurt your nipples, in which case you should stop using it until your nipples heal. You may find that hand-expressing your milk is more comfortable. While it’s not as easy as using a breast pump, it’s just as efficient once you get the hang of it. 
  • Waiting for long periods between feedings—feed your baby “on demand.” 
  • Excessive pressure on the breasts from tight clothing or bras. 
  • Allowing your breasts to become overly full for a very long time.

Mastitis (inflammation of the breast) is a common problem for breastfeeding women. Symptoms of mastitis include:

  • Tender, swollen breasts
  • Breast pain
  • Red, warm skin 
  • Fever
  • Flu-like symptoms

If your nipples become dry and cracked, bacteria can enter your breast during feeding or at any other time, leading to an abscess. 

Can I still breastfeed with an abscess or mastitis?

breast abscess: Mother carrying her baby while breastfeeding

It is usually safe to continue to breastfeed your baby as usual from both breasts if you have mastitis. 

Though you may object to the thought of nursing your baby when your breasts are in pain, breastfeeding will actually benefit you by: 

  • Clearing the milk ducts in your affected breast 
  • Relieving symptoms of pain and inflammation
  • Helping to avert an abscess

When breastfeeding, offer your baby the breast with the blocked duct first and let the baby feed until it is completely drained.

If you have a breast abscess, breastfeeding may be painful or difficult. Breastfeeding can continue from the affected breast as long as any drainage procedure doesn’t interfere. Express breast milk using a breast pump.

Your healthcare practitioner or a breastfeeding nurse (lactation consultant) will be able to advise you on the approach you should take. They can also offer general breastfeeding advice to help prevent mastitis in the future.

What are the symptoms of a breast abscess?

If you have developed a breast abscess, you may see or feel a mass or lump in your breast tissue. There could be redness and pain, as well as other symptoms of an infection. Breast abscess signs and symptoms may include:

  • Headache
  • Nausea
  • Vomiting
  • Flu-like symptoms
  • Fatigue
  • Breast pain
  • Localized heat or warmth in the breast
  • Nipple discharge
  • Flushed skin
  • Fever
  • The stopping or slowing of milk production for lactating women

When should I see my healthcare professional?

Mastitis can quickly progress to a breast abscess if it’s not treated promptly. If you suspect that you have mastitis or a breast abscess, don’t wait to see your medical provider. You should seek medical advice immediately

Contact your healthcare professional if you see:

• Pus or blood in your milk
• Red streaks 
• Symptoms of mastitis that start suddenly
• Severe symptoms of mastitis

Your clinician will ask a few questions about your symptoms and perform a physical exam of your breasts. They may also ask for an ultrasound, or they may take a biopsy of the fluid inside the lump in your breast. 

How is a breast abscess treated?

Doctor wearing a gloves examining the breast of a patient

Your medical provider may need to perform surgical drainage of the fluid from the lump. This simple outpatient procedure is done by extracting the fluid with a needle and syringe or by anesthetizing the area, making a small incision, and draining the fluid. 

Your clinician will likely use a needle aspiration if you are lactating or if the mass is less than three centimeters large.

There is a higher recurrence rate for breast abscesses in those who are not lactating, which means you may have more than one extraction or drainage procedure. 

If the drained abscess leaves a large cavity, a healthcare professional will need to pack it with gauze to help keep it dry and sanitary. The cavity will drain for a day or two. Keep the healing area clean and dry by replacing your bandages regularly with dry, sterile dressings.

Your doctor may prescribe antibiotic therapy, especially if the infection was caused by Staphylococcus aureus. Staphylococcus aureus is the most common type of bacteria that causes breast abscesses. It’s essential that you take the entire course of antibiotics as prescribed, even if you believe your symptoms have subsided.

Over-the-counter (OTC) pain medications such as acetaminophen or ibuprofen can offer pain relief. You can also use warm compresses to soothe the inflammation. 

Your clinician will likely ask you to make a follow-up appointment to ensure that your abscess has adequately healed.

Does a breast abscess mean breast cancer?

Breast cancer rarely causes pain and inflammation, and a breast abscess is not a sign of cancer. However, inflammatory breast cancer is an uncommon type of breast cancer that may produce symptoms similar to those of a breast abscess.

If you are not breastfeeding and don’t have other risk factors for an abscess, but you are experiencing breast abscess symptoms, contact your healthcare provider. You may want to go in for a clinical breast exam and a mammogram.

As the second leading cause of cancer in women, breast cancer is something we should all be vigilant about. Do your regular breast self-exams and schedule a regular annual screening mammogram

At Ezra, we are excited about our upcoming 3D mammogram program, which offers a more thorough breast cancer screening. It will soon be available in our New York center.