Nipple or Subareolar Abscess—Symptoms, Causes, and Treatment

Management of Breast Abscesses in the Nipple or Areola

If you've learned that you have a nipple or subareolar abscess you're probably feeling nervous. Why do these occur and could they be a symptom of breast cancer? 

Overview

A nipple or a subareolar abscess is a pocket of pus (like a cyst) that is located on your nipple or right beneath your areola. An abscess can press on nearby tissue and is often accompanied by swelling and inflammation. A nipple or a subareolar abscess may cause pain, a small tender lump, and drainage of pus.

Nipple and subareolar abscesses occur most commonly in women but have been found in men as well. There are a number of different bacteria which may be responsible, including the bacterium which causes tuberculosis. A subareolar abscess can also be referred to as an areolar gland abscess, Zuska's disease, or lactiferous fistula.

Causes

Areolar glands may become blocked, allowing bacteria that have found their way in to multiply. Your immune system goes into action to fight the infection, sending white blood cells into the blocked-up areas. When those blood cells, dead tissue, and bacteria stew together in the abscess pocket, pus forms.

If you have your nipple pierced and infection sets in, bacteria can get through the skin and cause a subareolar abscess. They are also more common in people with a history of diabetes.

Mastitis vs. Subareolar Abscess

Mastitis is a generalized infection in your breast but may sometimes result in abscess formation. It occurs most often when women are breastfeeding when a milk duct becomes plugged.

A subareolar abscess is essentially a "walled off" area of infection in which the body has contained the bacteria in one place by forming walls around the infected area of tissue. Risk factors in women who are not breastfeeding (and men) include diabetes, nipple piercing, and smoking.

Symptoms

The most common symptoms associated with a nipple or subareolar abscess include:

  • A swollen and tender area of tissue on your nipple or areola
  • Pus or discharge emerging from the swollen tissue
  • A fever
  • A general feeling of illness, similar to flu-like symptoms

When to See Your Doctor

Any painful lump under your nipple or areola should be checked by your doctor. If you are breastfeeding, abscesses can be common and are usually non-cancerous. However, if you are not breastfeeding, it has a potential to be a rare form of breast cancer. While the painful lump is most likely to be a benign condition, it may still require treatment, and it's important to see your doctor and have the lump evaluated.

Diagnosis

If you think your symptoms match those of a nipple or a subareolar abscess, see your doctor. You will have a visual examination, which may include a clinical breast exam and an ultrasound of the inflamed area. Your doctor may also recommend further testing depending on what she sees on your exam.

Treatment

For any breast abscess, antibiotics are usually recommended along with other treatments. For small abscesses, the treatment of choice is aspiration (drawing out the fluid and pus with a syringe) which can be used with or without ultrasound guidance.

Somewhat larger abscesses (over 3 cm or roughly an inch and a half in diameter) may require the placement of a percutaneous catheter. This is a small tube (catheter) which is inserted through the skin and into the abscess to allow for the continued drainage of any pus that develops.

Some abscesses are more difficult to treat and a surgical incision and drainage (I and D) may need to be done. This might be the case if your abscess is larger than 5 cm, if it is multiloculated (if the abscess has several compartments that are separated from each other making them difficult to drain through the skin), or if the abscess has been present for a long period of time. For persistent severe abscesses, it's sometimes necessary to surgically remove both the abscess and the glands in which they occur.

Antibiotics are needed to resolve the infection. After your abscess is drained, it's important to finish taking your antibiotics even if your symptoms have resolved. If the bacteria are not all killed in the abscess, your symptoms are more likely to recur.

In some cases, the abscess may persist or recur necessitating further treatment. Fortunately, there does not seem to be much information pointing to these abscesses as a risk factor for the later development of breast cancer. Scarring secondary to an abscess, however, can sometimes make mammogram readings more difficult.

A Word From Verywell

Have any painful lump in your nipple or aerola area checked by your doctor to ensure it is not a rare form of breast cancer and to get appropriate treatment. If you have had an areolar abscess drained, be sure that it is noted in your medical record so future mammogram results can be interpreted correctly.

Was this page helpful?
Article Sources