A breast abscess is a pocket of pus in the breast, most often a complication of mastitis in women who are breastfeeding. Staphylococcus aureus, including MRSA, is the usual cause, and the abscess needs drainage in addition to antibiotics.
Key symptoms
- Painful, swollen, red area of the breast
- Fever and chills
- Fatigue and body aches
- Mastitis that does not improve after 48 to 72 hours of antibiotics
What you find on exam
- Tender, warm, red breast lump
- Fluctuant mass
- Nipple discharge or skin breakdown
- Enlarged lymph nodes in the armpit
Tests
- Breast ultrasound to confirm a fluid collection
- Culture of the drained pus
- Blood count if the fever is high
- Imaging and biopsy if not breastfeeding or not resolving, to rule out cancer
Treatment basics
- Needle aspiration under ultrasound, repeated if needed
- Incision and drainage for large or recurrent abscesses
- Antibiotics such as dicloxacillin or cephalexin; trimethoprim-sulfamethoxazole or clindamycin if MRSA is likely
- Keep breastfeeding or pumping from the affected breast
- Pain control with ibuprofen or acetaminophen
Red flags
- Signs of sepsis: high fever, low blood pressure
- Rapidly spreading redness
- Abscess in a woman who is not breastfeeding (consider cancer)
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.