Skip to main content

For urgent surgical problems, please contact the nearest hospital emergency department.

Breast Abscess and Mastitis

Typical recovery: Clinical improvement usually begins after effective treatment and source control, but complete resolution varies with the severity and size of the infection. Pain and fever may improve over several days, while residual inflammation, induration or a small mass-like area can take several weeks to disappear completely. Some abscesses require repeated aspiration, drain management or additional procedures before final resolution.

Key points

  • Mastitis is a spectrum of breast inflammation and is not automatically a bacterial infection.
  • A breast abscess is a drainable collection and generally requires source control rather than antibiotics alone.
  • Ultrasound is the most useful initial imaging test when a breast abscess is suspected and can also guide treatment.
  • When technically feasible, percutaneous aspiration or drainage is generally preferred before routine open surgical drainage.
  • Needle aspiration may need to be repeated, while catheter or drain placement can provide ongoing drainage in selected patients.
  • Formal incision and drainage remains appropriate when minimally invasive drainage is unsuitable or unsuccessful.
  • Fluid obtained from an abscess should usually be sent for microbiological culture, particularly in recurrent infection, treatment failure or when resistant organisms are possible.
  • Breastfeeding usually does not need to stop because mastitis or a drained lactational breast abscess is present.
  • After aspiration or drain placement for a lactational abscess, breastfeeding from the affected breast can usually continue.
  • The goal in lactational mastitis is normal physiological milk removal, not repeated pumping to completely empty the breast.
  • Aggressive deep breast massage can worsen tissue inflammation and should be avoided.
  • Excessive pumping can increase milk production and contribute to ongoing inflammation in susceptible breastfeeding patients.
  • Ice and appropriate anti-inflammatory pain relief can reduce inflammation and discomfort in lactational mastitis.
  • Persistent or recurrent abscess in a non-lactating woman requires more careful assessment than a straightforward lactational infection.
  • Smoking and diabetes are important associations with recurrent non-lactational and periareolar breast abscesses.
  • Recurrent periareolar abscess or a mammary duct fistula may reflect underlying periductal mastitis and may eventually require definitive duct surgery.
  • A breast that remains abnormally inflamed, indurated or mass-like despite appropriate treatment requires imaging and sometimes tissue diagnosis to exclude another condition.
  • Progressive breast redness, skin thickening, retraction or peau d'orange that does not resolve as expected should not simply be assumed to represent infection.

Overview

Mastitis refers to inflammation of breast tissue and is especially common during breastfeeding. It exists along a spectrum ranging from inflammatory mastitis to bacterial mastitis, phlegmon and breast abscess. Not every painful red breast represents a bacterial infection, and antibiotics are not required for every early inflammatory episode. A breast abscess is a localised collection of infected fluid or pus and usually requires drainage in addition to appropriate medical treatment. Lactational abscesses often develop as a complication of mastitis, whereas non-lactational abscesses are more commonly associated with periductal mastitis, smoking, diabetes, nipple-related disease or an underlying breast disorder. Ultrasound is the main imaging test when an abscess is suspected because it can confirm a drainable collection and guide aspiration or catheter drainage. When technically appropriate, image-guided aspiration or percutaneous drainage is generally preferred before formal surgical incision and drainage because it can reduce tissue trauma and scarring. Some abscesses nevertheless require surgical drainage because of size, loculation, skin compromise, failure of percutaneous treatment or other clinical factors. In breastfeeding patients, drainage usually does not require stopping breastfeeding from the affected breast. Recurrent, atypical or non-resolving breast infection requires reassessment for an underlying condition such as periductal disease, granulomatous mastitis, diabetes, tuberculosis in an appropriate clinical setting or, less commonly, malignancy.

Signs & symptoms

  • A painful, tender area of the breast.
  • Redness, warmth and swelling of part of the breast.
  • A firm or indurated area associated with mastitis.
  • A painful fluctuant or increasingly prominent lump suggesting abscess formation.
  • Fever, chills, fatigue or flu-like symptoms, particularly with bacterial mastitis.
  • Persistent symptoms despite initial treatment for mastitis.
  • Drainage of pus through the skin or nipple in some non-lactational or recurrent infections.
  • Recurrent painful swelling close to the nipple or areola, particularly with periductal mastitis.
  • Breastfeeding difficulty because of pain or swelling.
  • A residual firm area after treatment, which may reflect persisting inflammation or phlegmon and should be followed until resolution.

How assessment and treatment are planned

  1. 1

    Take a focused history including duration of symptoms, breastfeeding status, recent nipple trauma, previous mastitis or abscess, diabetes, smoking, nipple piercing, previous breast procedures and antibiotic exposure.

  2. 2

    Examine both breasts and regional lymph nodes, assessing erythema, induration, tenderness, fluctuance, skin compromise, nipple changes and any spontaneously draining area.

  3. 3

    Differentiate uncomplicated inflammatory mastitis from bacterial mastitis, phlegmon and a mature drainable abscess.

  4. 4

    Arrange targeted breast ultrasound when abscess is suspected, the examination is uncertain, symptoms are persistent or recurrent, or a mass remains after treatment.

  5. 5

    Treat early lactational inflammatory mastitis with appropriate anti-inflammatory measures, physiological breastfeeding and avoidance of unnecessary breast trauma rather than automatically prescribing antibiotics.

  6. 6

    Use antibiotics when bacterial mastitis or abscess is clinically suspected, selecting treatment according to local resistance patterns, allergy history, breastfeeding considerations and culture results where available.

  7. 7

    Drain a confirmed breast abscess to achieve source control.

  8. 8

    Use ultrasound-guided needle aspiration with fluid sent for culture and sensitivity when appropriate. Some abscesses require repeated aspiration.

  9. 9

    Consider catheter or drain placement when a collection is likely to need ongoing drainage or repeated aspiration would be impractical.

  10. 10

    Use surgical incision and drainage when percutaneous treatment is unsuitable, has failed, or when the collection is large, complex, loculated, associated with threatened skin or otherwise requires operative management.

  11. 11

    In lactational abscess, support continued breastfeeding from the affected breast whenever clinically feasible after aspiration or drain placement.

  12. 12

    Reassess persistent, recurrent or atypical non-lactational abscesses for underlying periductal disease, granulomatous mastitis, diabetes, unusual infection or malignancy.

  13. 13

    After the acute infection has settled, consider definitive duct surgery in selected patients with recurrent periareolar abscess or mammary duct fistula caused by chronic periductal disease.

Preparation

  • Tell the surgeon whether you are currently breastfeeding, recently stopped breastfeeding or are not lactating.
  • If breastfeeding, describe feeding frequency, pumping practices, oversupply and any recent nipple trauma or feeding difficulty.
  • Bring previous breast ultrasound, mammography or other imaging reports and images if available.
  • Bring details of previous breast abscesses, drainage procedures, cultures and antibiotics.
  • Mention diabetes, immune-suppressing conditions, smoking and nipple piercings because these can affect recurrence and treatment.
  • Tell the clinician about any previous breast surgery or biopsy.
  • Bring a current medication list and details of any antibiotic allergies.
  • Tell the treating team about anticoagulants or antiplatelet medicines if aspiration, drainage or surgery may be required.
  • Do not stop prescribed blood-thinning medication without specific medical advice.
  • In recurrent or non-resolving disease, be prepared for additional imaging, culture or tissue sampling if the diagnosis is not straightforward.

Recovery and aftercare

  • Take prescribed antibiotics exactly as advised when bacterial infection is being treated.
  • Use appropriate pain relief and anti-inflammatory treatment when medically suitable.
  • After aspiration or drainage, keep the puncture or wound area clean and follow dressing instructions.
  • Attend follow-up if repeat aspiration, drain review or repeat ultrasound has been advised.
  • Seek reassessment if pain, fever or swelling increases rather than progressively improving.
  • In breastfeeding patients, continue physiological breastfeeding from the affected breast when advised and clinically feasible.
  • Do not repeatedly pump the breast purely to make it completely empty unless there is a specific reason to do so.
  • Avoid aggressive deep massage of inflamed breast tissue.
  • Cold packs can be used for symptomatic relief in lactational mastitis when comfortable.
  • A small residual firm area can persist for some time after an abscess or phlegmon, but it should progressively resolve and may require interval examination or ultrasound.
  • If a non-lactational or periareolar abscess keeps recurring, attend further evaluation rather than repeatedly treating each episode with antibiotics alone.
  • If smoking is contributing to recurrent periductal disease, smoking cessation forms an important part of long-term treatment.
  • If surgery is ultimately required for recurrent duct-related infection, definitive treatment is usually planned after the acute inflammation has settled.

Risks and possible complications

  • Progression of mastitis to a breast abscess.
  • Persistence or recurrence of an abscess after a single needle aspiration.
  • Need for repeated aspiration or placement of a drainage catheter.
  • Need for formal surgical drainage if percutaneous treatment does not adequately control the infection.
  • Bleeding or haematoma after aspiration or drainage.
  • Temporary pain and bruising after drainage.
  • Skin breakdown or spontaneous drainage when an abscess progresses close to the skin.
  • Scarring or breast contour change after a large infection or surgical drainage.
  • Milk leakage or milk fistula after drainage of a lactational abscess; this is uncommon and does not usually require stopping breastfeeding.
  • Recurrent periareolar infection or mammary duct fistula in chronic periductal mastitis.
  • Failure to identify an underlying disorder if recurrent or atypical infection is repeatedly treated without further assessment.
  • Delayed diagnosis of granulomatous mastitis, unusual infection or breast malignancy when persistent inflammation does not behave like an uncomplicated abscess.
  • Sepsis in severe untreated or inadequately controlled infection.

When to arrange prompt medical assessment

  • Increasing breast pain, redness or swelling that is not settling with initial supportive treatment.
  • Fever or systemic illness associated with a painful red breast.
  • Development of a focal painful lump suggesting a breast abscess.
  • Mastitis symptoms that fail to improve within approximately 24 to 48 hours after appropriate treatment.
  • Persistent or recurrent breast infection, particularly in a non-lactating woman.
  • A breast lump or firm area that remains after the acute infection appears to have resolved.
  • Recurrent swelling or pus drainage close to the nipple or areola.
  • Persistent nipple discharge, nipple retraction or another new nipple abnormality accompanying an infection.
  • Progressive skin thickening, peau d'orange appearance or breast distortion that does not resolve as infection improves.

When to go to an emergency department now

  • Rapidly worsening infection associated with severe systemic illness, confusion, faintness or signs of sepsis.
  • Rapidly progressive breast swelling and pain associated with spreading skin changes or tissue compromise.
  • Severe dehydration, persistent vomiting or inability to take oral fluids during a significant infection.

Myth vs fact

Frequently asked questions

Sources

Medically reviewed by Dr. Shams Alam Mohammed Tahir, MBBS, MS (General Surgery). Last reviewed 2026-09-18.

WhatsApp