Breast Cancer - Moose and Doc

A breast cancer explanations website

 

By Dr. Halls

Breast Abscess: Everything that you need to Know

An abscess is an accumulation of pus in breast tissue, that develops as a defensive reaction, usually against infection, but also due to the presence of foreign objects.

An abscess can occur anywhere in the body. Most breast abscesses develop in association with lactation and breastfeeding (mastitis), but not all. Breast abscesses occurring in non-lactating and postmenopausal women are a bit more unusual and would be suspicious, at least initially, for malignant breast cancer.

Because of this, a thorough evaluation, including a fluid aspiration, is usually necessary.

A family physician usually discovers an abscess clinically, or by a woman herself as a ‘lump’.  However, a mammogram may also sometimes reveal a breast abscess.

A woman who has already undergone breast cancer treatments or biopsies may also develop an abscess in the following days or weeks.

The symptoms of a breast abscess include:-

  • pain
  • fever
  • breast tenderness

However, not all abscesses present with obvious signs of inflammation, so diagnosing them is not always a simple matter.

breast abscess subareolar-xray

Just to let you know, that this page is somewhat old. So we would like you to visit our new and up-to-date page with more information on Breast Abscess. But this page is still valuable.

Release of cytokines can start an inflammatory response within the breast

When foreign organisms (bacteria) enter a wound, they can kill many of the local cells. These dying cells release cytokines (cytokines are small proteins that certain cells secrete which signal an immune system response).

The release of cytokines starts an inflammatory response, increasing blood flow and bringing large numbers of white blood cells to the region. As part of this immune system response, the healthy cells next to the area form a fibrous ‘wall’ or ‘capsule’.

Pus accumulates within this capsule, often forming a palpable bulge, or a ‘cavity’ within the breast.

Talking Moose
Talking Moose
It’s getting a little complicated here, Doc.


 
 

The image below shows the fibrous tissue of the encapsulating abscess wall, with a few inflammatory cells, and small amounts of pus.

abscess-fibrous-capsule

Specific causes of a breast abscess and the possibility of breast cancer

Staphylococcus aureus bacteria (a ‘staph’ infection) is a common cause for breast abscesses, especially in lactating and pregnant women.

An abscess can be thought of as a ‘skin’ complication really, and many abscesses are caused by bacteria commonly found on normal skin.

A ‘break‘ or tear in the skin allows bacteria to enter beneath the skin, and pus and inflammation accumulate. Some breast abscesses are also caused by tuberculosis (normally a lung condition).

In poorer parts of the world, up to 4% of all benign breast lumps examined are actually abscesses associated with tuberculosis. However, a breast abscess caused by TB is extremely rare in non-third-world countries.

Breast abscesses can be brought on by a variety of causes

There is speculation that steroid treatments, trauma, and even smoking can help bring about an abscess.  Other underlying conditions whereby the presenting symptom is a breast abscess include:-

Essentially, the development of an abscess in the absence of a clear ‘open wound’ or opportunity indicates that something is compromising the cells and tissues of the body’s immune response.

Or, it might mean that neoplastic cell growth or destruction in tissues such as the breast ducts  causes a build up of fluids (secretions), and these stagnant fluids are prone to infection.

In this instance, the presence of an abscess could be a byproduct of gland and tissue changes.  Occasionally,  a developing breast cancer can cause these changes. However, the vast majority of potential underlying causes turn out to be benign.

Treatment of a breast abscess

A surgeon or family physician will usually drain a breast abscess, either by surgical incision (or ‘lancing’) for large, progressive abscesses or by needle aspiration.

Usually the medic will not drain an abscess until the lesion transforms from a ‘harder’ serous inflammation to a  ‘softer’ pus stage.

Some breast abscesses will require multiple needle aspirations, but most show improvement and resolution with a single treatment. About 90% of breast abscesses can be managed by repeated needle aspirations rather than formal surgery. Many patients are also treated with antibiotics, depending on the individual and the type of bacteria found.

Dr. Halls Dr. Halls
Not all abscesses are big enough to need draining with a needle poke. Small ones, your body will cure on it’s own.


 
 

Inflammatory breast lesions are more suspicious for malignancy

Any inflammatory breast lesion in a postmenopausal women would carry some suspicions of malignancy.  So, after drainage of the abscess an excisional biopsy is usually undertaken.

If an ultrasound scan reveals an inflammatory mass that does not seem to transform into pus (a thick, sticky pale yellow or yellow-green fluid) and does not seem to respond to antibiotics, (and get smaller or resolve), then there must be the consideration of an underlying breast carcinoma.

Peripheral and Subareolar breast abscesses

In non-lactating women, breast abscesses tend to develop either below the nipple (the subareolar breast abscess) or around the breast periphery.  (Lactation-related abscesses tend to develop in and around the breast ducts).

Subareolar breast abscesses are a bit more troublesome in terms of management, because they tend to last longer and  recur. Even though it is a rare condition, these abscesses affect young women the most.

Cosmetically, a breast abscess can also cause deformation of the nipple and areola. Sub and periareolar (around the nipple) abscesses also frequently cause nipple discharges.

Subareolar abscesses might even require a more extensive surgical intervention, including the removal of any damaged ducts, (depending on the situation and underlying cause) and reconstruction of the nipple.

Imaging studies for breast abscesses

Even though imaging studies are frequently undertaken to rule out malignancy, mammograms and ultrasounds of breast abscesses are not always conclusive.

A breast abscess will likely appear on a mammogram as an ill-defined mass, typically with some areas of increased density and distortion. These types of features can not be confidently differentiated from breast cancer lesions. Mammography is also less sensitive for the diagnosis of younger women and those with dense breast tissue.

Ultrasound can help distinguish between an abscess and breast cancer

Ultrasound can be useful in ruling out malignancy, though depending on the location of the abscess, the sonograph image may not always make the picture any clearer.

A breast abscess will usually show on ultrasound as an ill-defined echogenic mass with central irregular hypoechogenicity or septations.

There may or may not be a posterior acoustic enhancement. Breast carcinoma, on the other hand, tends to show an as irregular hypoechoic mass, which may or may not have posterior acoustic shadowing.

However, when the abscess is right under the nipple and without a palpable mass, the abscess might not even show up on ultrasound at all. This is a situation where an MRI scan might be useful as it tends to provide a more comprehensive view of the lesion, even below the nipple.

breast-abscess-ultrasound

The goal is to avoid surgery if possible

Obviously, the goal of imaging studies regarding a breast abscesse is to rule out carcinoma and avoid unnecessary major surgeries.

Here are a few Q&A you may want to know…

Which antibiotics treat breast abscess?

  • Nafcillin
  • Vancomycin
  • Clindamycin
  • Ampicillin-sulbactam sodium
  • Dicloxacillin
  • Oxacillin.

What if a breast abscess bursts?

Yes, sometimes the breast abscess can burst in the middle of nowhere, and pus may be seen dribbling from an open point on the abscess. When this happens, whether spontaneously or surgically, it causes a reduction of the intensity of the pain.

What is breast abscess surgery?

The surgeon will remove the chronic abscess and any affected glands.  If there is nipple inversion due to the breast abscess, the surgeon can also perform nipple reconstruction.

The surgery may take place in a:-

  • Doctor’s office
  • Surgical outpatient center
  • A hospital

depending on the size and severity of the abscess.

What causes breast abscess?

A blocked duct or gland inside the breast can cause a breast abscess. This blockage can lead to an infection under the skin.  However, the most common cause of breast abscess is nipple piercings and jewellery.

How to cure breast abscess naturally?

If you are breastfeeding, then continue to breastfeed. This helps get rid of the infected milk and will not harm your baby.

How to prevent breast abscess?

Breastfeeding mothers who have mastitis, engorgement or plugged ducts should empty their breasts often. As well as using a warm compress on the breast before breastfeeding or pumping to increase the flow of the milk.

Further Reading

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References

About Steven Halls

Dr Halls has 25 years experience as a radiologist. He worked for 13 years at Cross Cancer Institute in Edmonton, a world-class cancer treatment facility. He has had high-volume experience with cancer, interventional procedures, clinical trials and his own phase 1 and 2 research in MRI and breast cancer staging.