One abscess It’s a pustule — a collection of fluid that the body’s immune system produces when it fights an infection. Abscesses can occur anywhere, but are usually found only under the skin.
A sort of under the areola A nipple abscess is a pocket of pus found on the breast below the nipple or areola. The areola is the ring of dark (pigmented) skin that surrounds the nipple. As the immune system fights the infection in the abscess, the area becomes inflamed and often swollen. Subareolar nipple abscesses may cause pain, small bumps, and discharge of pus.
Subareolar nipple abscesses are most common in young or middle-aged women who are not breastfeeding. They are also present in males.
An abscess occurs when bacteria that normally live on the skin enter the body through a cut, puncture, or other hole in the skin. There are many different bacteria that can cause an abscess. Often, when an abscess is drained, a sample is sent to a laboratory to help determine appropriate antibiotic treatment.
This article discusses the symptoms, causes, diagnosis, and treatment of subareolar nipple abscesses.
A subareolar nipple abscess may also be called an areolar gland abscess, Zuska’s disease, or a lactiferous fistula.
part of the outer breast
The most common symptoms associated with subareolar nipple abscesses include:
- swollen and tender areas of tissue on the nipple or areola
- Pus or discharge from swollen tissue
- General feeling unwell, similar to flu-like symptoms
Breasts have glands in the areola (areolar glands), which are modified sweat glands that open on the surface of the skin. Bacteria sometimes enter the glands. If the areola glands are blocked, bacteria can multiply under the skin.
As the bacteria multiply, the immune system is activated to fight local infections. White blood cells enter the blocked area. Then, pus forms when white blood cells, dead tissue, and bacteria build up in the abscess pocket.
Possible risk factors for a subareolar abscess include:
- autoimmune disease
Any painful lumps under the nipple or areola should be evaluated by your healthcare provider. Although a painful lump is most likely a benign condition, it may still require treatment.
Clinical breast exams, mammograms, breast ultrasounds, MRIs, and breast biopsies are all used by medical teams to determine the cause of any painful breast lumps. Your provider may suggest further testing based on what they saw on your exam.
You may have been diagnosed with one of the following conditions:
- A subareolar abscess is essentially a “closed” infection in which the body holds bacteria in one place by forming a wall around the infected tissue area. Breast ultrasound and fine needle aspiration (FNA) are commonly used to diagnose subareolar abscesses. The material drained from the abscess is sent to a laboratory to identify infectious bacteria to guide the choice of antibiotic medication.
- Mastitis is a systemic inflammation caused by blocked breast ducts. Mastitis may or may not have an infection (bacteria in the ducts). A mastitis infection can sometimes develop into an abscess.
- Inflammatory breast cancer is a rare type of breast cancer that can also cause blocked ducts and painful swelling/inflammation of breast tissue. Breast biopsy is the best way to definitively identify cancer.
Antibiotics and other treatments are usually recommended for any breast abscess. For small abscesses, the treatment of choice is aspiration (drawing out the fluid and pus with a syringe). Suction can be performed with or without ultrasound guidance.
Larger abscesses—more than 3 centimeters (cm) or about an inch and a half in diameter—may require placement of a percutaneous catheter. This is a small tube that is inserted through the skin into the abscess to allow continued drainage of any pus that forms.
Some abscesses are more difficult to treat and may require surgical incision and drainage (I&D).This may occur if the abscess is larger than 5 cm multi-room (several compartments are separated from each other, making them difficult to drain), or if the abscess has been around for a long time.
For persistent severe abscesses, surgery is sometimes necessary to remove the abscess and the gland in which it developed. In some cases, the abscess may persist or recur and require further treatment.
Antibiotics are needed to resolve the infection associated with the abscess. After the abscess drains, antibiotics must be completed, even if your symptoms have gone away. If all the bacteria in the abscess has not been killed, your symptoms are more likely to come back.
Fortunately, there doesn’t seem to be much to suggest that these abscesses are a risk factor for developing breast cancer later on. However, scarring from an abscess can sometimes make mammograms more difficult.
Subareolar abscesses in men are very rare, but when they occur, aggressive treatment with complete removal of the catheter is recommended.
In men, breast abscesses are often accompanied by fistulas, which are abnormal passages between the ducts and the skin of the areola. Abscesses usually recur if not completely removed.
Subareolar nipple abscesses can occur in both women and men. They are usually painful lumps in the area around the nipple. While they are usually easily drained and treated with antibiotics, there are some very serious illnesses with similar symptoms. If you have any symptoms of a breast abscess, be sure to have your breasts checked by your healthcare provider.
Have your healthcare provider check your nipple or areola area for any painful lumps to make sure it’s not a rare form of breast cancer and is being treated appropriately. If you have drained a subareolar nipple abscess, be sure to note it in your medical record so future mammogram results can be properly interpreted.
Frequently Asked Questions
What causes a subareolar nipple abscess?
A nipple abscess occurs when the glands in the areola (around the nipple) become blocked and bacteria become trapped in it. The immune system sends white blood cells into the blockage to fight infection. This can cause pus to form in the abscess bag.
Is a breast abscess serious?
Breast abscesses can be serious and usually require antibiotics. In more severe cases, needle aspiration, surgical drainage, drains, or surgical excision may be required.
How do you treat a subareolar abscess at home?
You should see your healthcare provider to properly diagnose and treat a breast abscess. You can relieve the pain of an abscess at home with warm compresses and over-the-counter pain relievers.
Which antibiotics are used to treat subareolar abscesses?
Subareolar abscesses usually require antibiotic treatment for 4 to 7 days. Common antibiotics used to treat breast abscesses include amoxicillin, clindamycin, doxycycline, trimethoprim, nafcillin, or vancomycin. If you’re breastfeeding, make sure your healthcare provider knows so they can choose a different antibiotic if needed.