An Overview of Subareolar Nipple Abscess

An abscess is a pocket of pus—a collection of fluid produced by the body’s immune system when fighting an infection. Abscesses can occur anywhere but are commonly found just under the skin.

A subareolar nipple abscess is a pocket of pus found on the breast in the nipple or beneath your areola. The areola is the ring of darker (pigmented) skin that circles the nipple. When the immune system fights the infection in the abscess, the area becomes inflamed and often swells. A subareolar nipple abscess may cause pain, a small tender lump, and drainage of pus.

Subareolar nipple abscesses occur most commonly in younger or middle-aged women who are not breastfeeding. They have been found in men as well.  

An abscess occurs when bacteria that normally live on the skin enter the body through a cut, puncture, or another hole in the skin. Several different bacteria may be responsible for causing an abscess. Usually, when the abscess is drained, a sample is sent to the lab to help determine the appropriate antibiotic treatment.

This article discusses the symptoms, causes, diagnosis, and treatment of subareolar nipple abscesses.

Symptoms

The most common symptoms associated with a subareolar nipple 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

Causes

The breasts have glands in the areolas (areolar glands), which are modified sweat glands that open on the skin's surface. Bacteria can sometimes find their way into the glands. For example, bacteria multiply underneath the skin if the areolar glands become blocked.

As the bacteria multiply, the immune system is activated to fight the local infection. White blood cells move into the blocked-up areas. Then, pus forms when white blood cells, dead tissue, and bacteria build up in the abscess pocket.

Possible risk factors for subareolar abscess include:

• Smoking
• Autoimmune disease
• Infection
• Trauma
• Breastfeeding
• Diabetes
  

Diagnosis

Any painful lump under your nipple or areola should be evaluated by your healthcare provider. While the painful lump is most likely to be a benign condition, it may still require treatment.

Clinical breast exam, mammogram, breast ultrasound, MRI, and breast biopsy are all used by medical teams to determine the cause of any painful breast lump. Your healthcare provider may recommend further testing depending on what they see on your exam.

You may be diagnosed with one of the following:

• Subareolar abscess is essentially a "walled off" infection in which the body has contained the bacteria in one place by forming walls around the infected area of tissue. Breast ultrasound and fine-needle aspiration (FNA) are often used to diagnose subareolar abscesses. The material drained from the abscess is sent to the lab to identify the infectious bacteria to guide antibiotic medication choices. 
• Mastitis is a generalized inflammation in your breast from a clogged milk duct. There may or may not be an infection (bacteria in the duct) with mastitis. A mastitis infection can sometimes develop into an abscess.  
• Inflammatory breast cancer is a rare form of breast cancer that can also cause blocked ducts and painful swelling/inflammation of the breast tissue. A breast biopsy is the best way to definitively identify cancer.

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). Aspiration can be done with or without ultrasound guidance.

Somewhat larger abscesses—over 3 centimeters (cm) or roughly 1 inch and a half in diameter—may require the placement of a percutaneous catheter. This is a small tube that 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&D) may need to be done. This might be the case if the abscess is larger than 5 centimeters, multiloculated (has several compartments separated from each other, making them difficult to drain), or has been present for a long time.

For persistent severe abscesses, it is sometimes necessary to surgically remove the abscess and the glands in which they occur. However, the abscess may persist or recur in some cases, necessitating further treatment.

Fortunately, there does not seem to be much indication that these abscesses are a risk factor for developing breast cancer later. However, scarring caused by an abscess can sometimes make mammogram readings more difficult.

Treatment in Men

Subareolar abscesses in men are very uncommon, but when they occur, it is recommended that they be treated aggressively with complete excision of the duct.

In men, breast abscesses are often complicated by fistulas, abnormal passageways between the duct and the skin of the areola. If not completely removed, the abscesses commonly recur.

Summary

Subareolar nipple abscesses can occur in women or men. They are often painful lumps in the area around the nipple. While they are generally easily drained and treated with antibiotics, there are a few very serious medical conditions with similar symptoms. Be sure to have your breast examined by your healthcare provider if you have any symptoms of a breast abscess.

A Word From Verywell

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