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# Breast abscess

A breast abscess is a pocket of pus in the breast, usually a complication of mastitis during breastfeeding or of inflammation behind the [nipple](https://durgical.com/en/anatomy/nipple/).

Updated 2026-10-29

## Structures involved

Tap one to see what it is and open it in 3D.

- [Breast fat](https://durgical.com/en/anatomy/body-of-breast/)
- [Mammary gland lobes](https://durgical.com/en/anatomy/mammary-gland/)
- [Lactiferous ducts](https://durgical.com/en/anatomy/lactiferous-ducts/)
- [Areola](https://durgical.com/en/anatomy/areola/)
- [Nipple](https://durgical.com/en/anatomy/nipple/)
- [Retromammary space](https://durgical.com/en/anatomy/pectoral-fascia/)

## Microorganisms that cause it

- [Staphylococcus aureus](https://durgical.com/en/microbiology/staphylococcus-aureus/)

## In the clinical exam

- [Clinical breast examination](https://durgical.com/en/clinical-exam/clinical-breast-examination/)

## In physiology

- [Lactation](https://durgical.com/en/physiology/lactation/)

## Why it happens

- [Outcomes of acute inflammation: resolution, abscess, scar or chronic inflammation](https://durgical.com/en/general-pathology/outcomes-of-acute-inflammation-resolution-abscess-scar-or-chronic-inflammation/)
- [Breast: ducts, lobules and changes with life stage](https://durgical.com/en/histology/breast-ducts-lobules-and-changes-with-life-stage/)

## What it is

A localised collection of pus in the breast, usually as a complication of lactational mastitis or, outside lactation, of periductal inflammation behind the nipple.

## Who gets it

Develops in a small fraction of women with lactational mastitis. Non-lactational abscesses near the [areola](https://durgical.com/en/anatomy/areola/) affect mainly young to middle-aged women who smoke and tend to recur.

## Causes

- Complication of lactational mastitis
- Periductal mastitis and duct ectasia (non-lactational, subareolar)
- Staphylococcus aureus, including methicillin-resistant strains; mixed and anaerobic bacteria in non-lactational abscesses
- Infected cysts or skin infections

## Risk factors

- Mastitis that is delayed or inadequately treated
- Abrupt cessation of breastfeeding
- Smoking (subareolar abscess)
- Diabetes and obesity
- Nipple piercing
- Previous abscess

## Pathophysiology

Infection that is not cleared leads to tissue necrosis, and the body walls off the pus in a cavity. Antibiotics penetrate the cavity poorly, so drainage is needed. In subareolar abscesses, blocked and inflamed ducts behind the nipple can form a fistula to the skin.

## Classification

- Lactational (usually peripheral)
- Non-lactational (subareolar or peripheral)
- Single or multiloculated

## Symptoms and signs

- Painful, swollen, red lump in the breast
- Fluctuance (may be absent in deep abscesses)
- Fever and malaise
- Skin thinning or spontaneous drainage of pus
- Nipple retraction in subareolar abscess

## Red flags

- Signs of sepsis
- Skin necrosis
- Recurrent abscess or fistula
- Abscess in a non-lactating, older woman or that does not resolve (possible cancer)

## Diagnosis

**Clinical**
A painful, red, fluctuant lump, often after mastitis.

**Tests**
Culture of the drained pus to guide antibiotics; blood tests if systemically unwell; tissue sampling of the wall when cancer is a concern.

**Imaging**
Ultrasound confirms the collection, measures it and guides drainage; mammography after recovery in older women or when cancer must be excluded.

## Differential diagnosis

- Mastitis without abscess
- Galactocele
- Inflammatory breast cancer
- Infected cyst
- Idiopathic granulomatous mastitis

## Goal of treatment

Drain the pus, eradicate infection, allow breastfeeding to continue when possible and prevent recurrence, while excluding cancer.

## Treatment

**Procedure**
Ultrasound-guided needle aspiration, often repeated, or placement of a small drain; first-line for most abscesses.

**Medical**
Antibiotics active against Staphylococcus aureus, adjusted to culture; broader cover for non-lactational abscesses.

**Surgical**
Surgical incision and drainage for large or multiloculated abscesses, failed aspiration or necrotic [skin](https://durgical.com/en/anatomy/skin/); excision of the diseased ducts for recurrent subareolar abscess.

**Conservative**
Analgesia and continued breastfeeding or expressing, at least from the unaffected breast; the affected side depends on the drainage site.

**Lifestyle**
Smoking cessation in non-lactational abscess, which lowers recurrence.

## Complications

- Recurrence
- Mammary duct fistula
- Milk fistula after drainage
- Scarring and breast deformity
- Sepsis

## Prognosis

Good with drainage and antibiotics; lactational abscesses usually heal without recurrence. Subareolar abscesses in smokers recur more often and may need duct surgery.

## Prevention

- Early and complete treatment of mastitis with continued milk removal
- Avoiding sudden weaning
- Not smoking

## Test yourself

Think of the answer, then tap the question to see it.

## What is the first-line treatment of a breast abscess?

Ultrasound-guided needle aspiration or catheter drainage, plus antibiotics active against Staphylococcus aureus.

## Why are antibiotics alone usually not enough for a breast abscess?

They penetrate the walled-off pus poorly, so the collection must be drained.

## Which habit is strongly linked to non-lactational subareolar abscesses?

Smoking, which is associated with periductal mastitis and recurrence.

## When should cancer be excluded in a breast abscess?

In non-lactating or older women, or when the abscess does not resolve or recurs.

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## Related conditions

- [Acute mastitis](https://durgical.com/en/conditions/acute-mastitis/)
- [Breast cancer](https://durgical.com/en/conditions/breast-cancer/)
- [Gynaecomastia](https://durgical.com/en/conditions/gynaecomastia/)

Educational information, not medical advice. For any symptom, see a health professional.

Sources: [Breast Abscess](https://www.ncbi.nlm.nih.gov/books/NBK459122/) (StatPearls (NCBI Bookshelf), 2026).

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Source: https://durgical.com/en/conditions/breast-abscess/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/conditions/breast-abscess/