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One type of breast infection that can occur in nonlactating women is a subareolar breast abscess. Subareolar breast abscesses are infected lumps that occur just under the areola, the colored skin around the nipple. An abscess is a swollen area in the body that is filled with pus. Pus is liquid filled with dead white blood cells.
The swelling and pus are due to a local infection. A local infection is where bacteria invade your body at a certain point and remain there. The bacteria do not spread to other parts of your body in a local infection.
In the past, these infections were called "lactiferous fistulas" or "Zuska’s disease," after the doctor who first wrote about them.
When a subareolar breast abscess first develops, you may notice some pain in the area. There will likely be a lump under the skin and some swelling of nearby skin. Pus may drain out of the lump if you push on it or if it is cut open.
If left untreated, the infection can start to form a fistula. A fistula is an abnormal hole from the duct out to the skin. If the infection is severe enough, nipple inversion can occur. This is when the nipple is drawn into the breast tissue rather than pointing out. You may also have a fever and a general feeling of ill health.
A subareolar breast abscess is caused by a blocked duct or gland inside the breast. This blockage can lead to an infection under the skin. Subareolar breast abscesses usually occur in younger or middle-aged women who aren’t currently breast-feeding.
Some risk factors for subareolar breast abscesses in nonlactating women include:
Abscesses in the breast often occur in lactating women who are breast-feeding. Mastitis is an infection in lactating women that causes swelling and redness in the breast area, among other symptoms. Mastitis can occur when a milk duct becomes plugged. If left untreated, mastitis can lead to abscesses in the breast.
Subareolar abscesses involve the nipple tissue or areolar glands. They usually occur in young or middle-aged women.
Your doctor will perform a breast exam to assess the lump.
Any pus may be collected and sent to a lab to determine what type of infection you have. Your doctor may need to know exactly what kind of bacteria are causing your infection since some bacteria are resistant to certain medications. This will allow your doctor to provide the best form of treatment for you. Blood tests may also be ordered to look for infection and to check your immune health.
An ultrasound of your breast may also be done to determine what structures under the skin are being affected and how deep your abscess goes beneath your areola. Occasionally, an MRI scan may be done as well, especially for a severe or a recurrent infection.
The first stage of treatment is taking antibiotics. Depending on the size of the abscess and your level of discomfort, your doctor may also want to open up the abscess and drain the pus. This would mean the abscess would be cut open in the doctor’s office. Most likely, some local anesthetic will be used to numb the area.
If the infection doesn’t go away with a course or two of antibiotics, or if the infection comes back repeatedly after initially clearing up, you may need surgery. During surgery, the chronic abscess and any affected glands will be removed. If nipple inversion has occurred, the nipple can be reconstructed during surgery.
Surgery may be done in your doctor’s office, in a surgical outpatient center, or in a hospital, depending on the size and severity of the abscess.
Abscesses and infections can recur even after you’ve been treated with antibiotics. Surgery may be required to remove the affected glands in order to prevent recurrence.
Nipple inversion can occur. Your nipple and areola can also be deformed or pushed off center by the abscess, causing cosmetic damage, even if the infection is successfully treated with antibiotics. There are surgical solutions to these complications.
In most cases, nipple problems or abscesses don’t indicate breast cancer. However, any infection in a woman who isn’t breast-feeding has the potential to be a rare form of breast cancer. According to the American Cancer Society, inflammatory breast cancer can sometimes be confused with an infection. Contact your doctor if you think you may have a subareolar breast abscess.
Most breast abscesses are cured with antibiotic treatment or by having the abscess drained. However, sometimes recurring or severe infections require surgery. Most of the time, surgery is successful in preventing the abscess and infection from returning.
Since a subareolar breast abscess is an infection, you will require antibiotics to reduce bacteria’s presence. However, there are some at-home treatments you can use that can reduce pain and discomfort while you are healing your subareolar breast abscess:
Practicing good hygiene, keeping the nipple and areola very clean if you have a piercing, and not smoking can help prevent subareolar breast abscesses. However, because doctors don’t know specifically what causes them, there are not currently other means for prevention.
Written by: Christine Case-Lo
Medically reviewed on: Jul 26, 2016: Debra Sullivan, PhD, MSN, CNE, COI
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