An Overview of Subareolar Nipple Abscess

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A subareolar nipple abscess is a pocket of pus located on your nipple or beneath your areola, the ring of pigmented skin surrounding your nipple. An abscess can press on nearby tissue and is often accompanied by swelling and inflammation. 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, but they've been found in men as well. There are a number of different bacteria that may be responsible, including the bacterium that causes tuberculosis.

A subareolar nipple abscess can also be referred to as an areolar gland abscess, Zuska's disease, or lactiferous fistula.

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
symptoms of subareolar nipple abscess
Verywell / Emily Roberts

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. It's also more common in people with a history of diabetes.

Diagnosis

Any painful lump under your nipple or areola should be checked by your healthcare provider. If you're breastfeeding, abscesses (mastitis) can be common and are usually noncancerous. However, if you're not breastfeeding, it has the 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 have the lump evaluated by your healthcare provider.

You'll have a visual examination, which may include a clinical breast exam and an ultrasound of the inflamed area. Your healthcare provider may also recommend further testing depending on what they see on your exam.

The differential diagnosis will include mastitis, which is a generalized infection in your breast that may sometimes result in abscess formation. It most often occurs when women are breastfeeding and a milk duct becomes plugged.

In contrast, 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.

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 done with or without ultrasound guidance.

Somewhat larger abscesses—over 3 centimeters (cm) or roughly an inch and a half in diameter—may require the placement of a percutaneous catheter. This is a small tube that's 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 cm, is multiloculated (has several compartments separated from each other, making them difficult to drain), 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.

Treatment in Men

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

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

Frequently Asked Questions

What causes a subareolar nipple abscess? 

A nipple abscess occurs when areolar glands become blocked and bacteria become trapped in them. The immune system sends white blood cells into the clog to fight the infection. This can lead to pus forming in the abscess pocket. 

Is a breast abscess serious?

A breast abscess can be serious and typically requires antibiotics. In more severe cases, needle aspiration, surgical drainage, a drainage tube, or surgical removal may be required.

How do you treat a subareolar abscess at home?

A breast abscess should be seen by a healthcare provider. You can relieve the pain of an abscess at home with a warm compress and over-the-counter pain relievers.

What antibiotics treat subareolar abscesses? 

Subareolar abscesses usually require antibiotic treatment for four to seven days. Common antibiotics used to treat breast abscesses include amoxicillin, clindamycin, doxycycline, trimethoprim, nafcillin, or vancomycin.

A Word From Verywell

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

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5 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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