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Breast Abscess and Masses

  • Author: Andrew C Miller, MD; Chief Editor: Jeter (Jay) Pritchard Taylor, III, MD  more...
Updated: May 24, 2016


Breast masses are broadly classified as benign or malignant. Common causes of a benign breast mass include fibrocystic disease, fibroadenoma (see the image below), intraductal papilloma, and abscess. Malignant breast disease encompasses many histologic types that include, but are not limited to, infiltrating ductal or lobular carcinoma, in situ ductal or lobular carcinoma, and inflammatory carcinoma. The main concern of many women presenting with a breast mass is the likelihood of cancer. Reassuringly, most breast masses are benign.

Ultrasonogram demonstrates a hypoechoic mass with Ultrasonogram demonstrates a hypoechoic mass with smooth, partially lobulated margins typical of a fibroadenoma.

See Breast Lumps in Young Women: Diagnostic Approaches, a Critical Images slideshow, to help identify and manage palpable breast lumps in young women.

Breast infections are divided into lactational and nonlactational infections. This division is also referred to as puerperal versus nonpuerperal when the process is not associated with pregnancy. The process may be confined to the skin overlying the breast, or it may result from an underlying lesion (eg, sebaceous cyst), as in hidradenitis suppurativa.[1, 2, 3, 4]



The mammary glands arise along the milk lines that extend along the anterior surface of the body from the axilla to the groin. During puberty, pituitary and ovarian hormonal influences stimulate female breast enlargement, primarily owing to accumulation of adipocytes. Each breast contains approximately 15-25 glandular units know as breast lobules, which are demarcated by Cooper ligaments. Each lobule is composed of a tubuloalveolar gland and adipose tissue. Each lobule drains into the lactiferous duct, which subsequently empties onto the surface of the nipple. Multiple lactiferous ducts converge to form one ampulla, which traverses the nipple to open at the apex.[5]

Below the nipple surface, lactiferous ducts form large dilations called lactiferous sinuses, which act as milk reservoirs during lactation.[6] When the lactiferous duct lining undergoes epidermalization, keratin production may cause plugging of the duct, resulting in abscess formation.[7, 8] This may explain the high recurrence rate (an estimated 39%-50%) of breast abscesses in patients treated with standard incision and drainage, as this technique does not address the basic mechanism by which breast abscesses are thought to occur.

Postpartum mastitis is a localized cellulitis caused by bacterial invasion through an irritated or fissured nipple. It typically occurs after the second postpartum week and may be precipitated by milk stasis.[9] There is usually a history of a cracked nipple or skin abrasion. Staphylococcus aureus is the most common organism responsible, but Staphylococcus epidermidis and streptococci are occasionally isolated. Drainage of milk from the affected segment should be encouraged and is best achieved by continuing breastfeeding or use of a breast pump.[3, 8, 4]

Nonlactating infections may be divided into central (periareolar) and peripheral breast lesions. Periareolar infections consist of active inflammation around nondilated subareolar breast ducts—a condition termed periductal mastitis. Peripheral nonlactating breast abscesses are less common than periareolar abscesses and are often associated with an underlying condition such as diabetes, rheumatoid arthritis, steroid treatment, granulomatous lobular mastitis, and trauma.[1, 10, 11] Primary skin infections of the breast (cellulitis or abscess) most commonly affect the skin of the lower half of the breast and often recur in women who are overweight, have large breasts, or have poor personal hygiene.[3]

Breast masses can involve any of the tissues that make up the breast, including overlying skin, ducts, lobules, and connective tissues. Fibrocystic disease, the most common breast mass in women, is found in 60%-90% of breasts during routine autopsy. Fibroadenoma, the most common benign tumor, typically affects women younger than 30 years and accounts for 91% of all solid breast masses in females younger than 19 years.[5] Infiltrating ductal carcinoma is the most common malignant tumor; however, inflammatory carcinoma is the most aggressive and carries the worst prognosis.




United States

After skin cancer, breast cancer is the most commonly diagnosed cancer in women. It accounts for approximately 1 in 4 cancers diagnosed in US women.[12]

Breast infections occur in as many as 10%-33% of lactating women.[13, 14]

Lactational mastitis is seen in approximately 2%-3% of lactating women,[6, 15, 4] and breast abscess may develop in 5%-11% of women with mastitis.[15, 4]


Breast mass

Morbidity and mortality depends on etiology.

Approximately 1 in 28 women (3.6%) die of breast cancer. In 2009, approximately 40,170 women were expected to die from breast cancer, second only to lung cancer.[12]

Associated morbidity may include scarring, disfigurement, lymphedema, and significant psychologic stress.

Breast abscess

Recurrent or chronic infections, pain, and scarring are causes of morbidity.

Mastitis is usually seen in lactating women, but the presence in a nonlactating woman should spur evaluation for an inflammatory carcinoma, newly onset diabetes, infection withMycobacterium tuberculosis, and other idiopathic causes.[3, 11]

Abscess formation complicates postpartum mastitis in fewer than 10% of cases.

Neonatal mastitis usually occurs in term or near-term infants, is twice as common in females, and progresses to development of a breast abscess in approximately 50% of cases.[16, 17, 5]


African American women have a higher incidence of breast cancer before age 40 years and are more likely to die of breast cancer at every age.

White women have a higher incidence of breast cancer than African American women after age 40 years.[18]

Race does not appear to be a factor in the incidence of developing a breast abscess.[19]


More than 99% of breast cancers are found in women; 0.7% of breast cancers occur in men. Men with changes in breast size should undergo diagnostic workup completed as aggressively as in women.[16, 17, 20, 21]


Fibroadenoma, a benign condition, is the most common cause of breast mass in women younger than 35 years.[5]

Women aged 40 years or older account for more than 95% of new breast cancer diagnoses and 97% of breast cancer deaths.

The median age at breast cancer diagnosis is 61 years.

Breast infections most commonly affect women aged 18-50 years.[3]

Nonpuerperal breast masses encompass a wider range of ages, from the late second to eighth decade of life. Peak incidence is often in the fourth decade of life. Ninety-five percent of these infections occur in women.[8]

Puerperal breast abscesses and mastitis are commonly found in women of childbearing age (mean age of 32 years).[1]

Access to care

Women who reside in rural settings may be more likely to present with a more advanced cancer stage than women in urban settings. This may partly result from the availability of and access to effective screening tools and primary care.[22]

Contributor Information and Disclosures

Andrew C Miller, MD Vice Chair of Research, Department of Emergency Medicine, Ruby Memorial Hospital, West Virginia University School of Medicine

Andrew C Miller, MD is a member of the following medical societies: American College of Emergency Physicians, Society of Critical Care Medicine

Disclosure: Nothing to disclose.


John W Hall, IV West Virginia University School of Medicine

John W Hall, IV is a member of the following medical societies: American Medical Association, American Medical Student Association/Foundation, Phi Beta Kappa

Disclosure: Nothing to disclose.

Suha Abdulkarim Khafaji, MBBS Research Physician, Department of Emergency Medicine, West Virginia University School of Medicine

Disclosure: Nothing to disclose.

Joseph J Minardi, MD Associate Professor, Department of Emergency Medicine, Department of Medical Education, West Virginia University School of Medicine; Director of Emergency Ultrasound, Department of Emergency Medicine, West Virginia University Hospitals

Joseph J Minardi, MD is a member of the following medical societies: Academy of Emergency Ultrasound, American College of Emergency Physicians, American Institute of Ultrasound in Medicine, American Medical Association, American Registry for Diagnostic Medical Sonography, American Society of Echocardiography, Emergency Ultrasound Fellowship, Society for Academic Emergency Medicine, Society of Ultrasound in Medical Education

Disclosure: Received income in an amount equal to or greater than $250 from: General Electric.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Barry J Sheridan, DO Chief Warrior in Transition Services, Brooke Army Medical Center

Barry J Sheridan, DO is a member of the following medical societies: American Academy of Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Jeter (Jay) Pritchard Taylor, III, MD Assistant Professor, Department of Surgery, University of South Carolina School of Medicine; Attending Physician, Clinical Instructor, Compliance Officer, Department of Emergency Medicine, Palmetto Richland Hospital

Jeter (Jay) Pritchard Taylor, III, MD is a member of the following medical societies: American Academy of Emergency Medicine, South Carolina Medical Association, Columbia Medical Society, South Carolina College of Emergency Physicians, American College of Emergency Physicians, American Medical Association, Society for Academic Emergency Medicine

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Chief Editor for Medscape.

Additional Contributors

Caitlin Kennedy, MD Resident Physician, Department of Emergency Medicine, West Virginia University School of Medicine

Caitlin Kennedy, MD is a member of the following medical societies: American College of Emergency Physicians, American Medical Association, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.


The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous authors, Sadia Hussain, MD, Tajinderpal Saraon, MD, Mark Silverberg, MD, Howard A Blumstein, MD, and Amy K Rontal, MD, to the development and writing of this article.

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Ultrasonogram demonstrates a hypoechoic mass with smooth, partially lobulated margins typical of a fibroadenoma.
Craniocaudal mammograms obtained 1 year apart demonstrate a newly developing mass in the outer part of the breast.
Spot compression mammogram of the outer part of the breast demonstrates a new mass as smooth, margined, and oval. The findings are consistent with a fibroadenoma, a cyst, or a malignancy. In this patient, the diagnosis was a rapidly growing fibroadenoma.
Eggshell or rim calcifications (arrows) have walls thinner than those of lucent-centered calcifications.
This mass with associated large, coarse calcifications (arrows) is a degenerating fibroadenoma.
Breast cancer, ultrasonography. Mediolateral oblique digital mammogram of the right breast in a 66-year-old woman with a new, opaque, irregular mass approximately 1 cm in diameter. The mass has spiculated margins in the middle third of the right breast at the 10-o'clock position. Image demonstrates both the spiculated mass (black arrow) and separate anterior focal asymmetry (white arrow).
Breast cancer, ultrasonography. Antiradial sonogram of the spiculated mass (shown in the image above) demonstrates a hypoechoic mass with angular margins (black arrows). Cursors on the margins of the mass were used to electronically measure its dimensions of the mass, which was 0.9 X 0.8 cm.
Breast cyst. A) A simple, fairly round breast cyst with hypo or anechoic contents and well-defined borders; B) Posterior acoustic enhancement is seen as well as edge shadows (arrows).
Breast adenoma. A) A breast adenoma is oval with well-defined borders. It may be hypoechoic and some internal echogenicity may be seen. It is wider than tall and posterior acoustic enhancement is NOT seen, helping distinguish from a cyst or other fluid collection. B) An arrow indicates the adenoma.
Breast hematoma. A) A breast hematoma is seen as a round echogenic collection with surrounding tissue edema. A hematoma may be hypoechoic, mixed, or fairly echogenic depending on the stage of the hematoma. B) The hematoma is outlined and tissue edema noted.
Loculated breast abscess. A) A large loculated abscess is seen containing hypoechoic fuid and some internal echoes. Posterior acoustic enhancement is seen. Care must be taken to image at an adequate depth to visualize posterior borders of breast lesions. B) The abscess is outlined in yellow and the posterior acoustic enhancement is noted.
Loculated breast abscess, curvilinear. A) This is the same abscess seen in the above image and is imaged with a curvilinear transducer to better appreciate the extent of the abscess. It is important to image the abscess completely for width and depth. B) The abscess is outlined in yellow and the ribs and posterior acoustic enhancement are noted.
Purulent breast abscess. A) A purulent breast abscess is seen. The fluid is echogenic, but can be recognized as a disruption of the surrounding tissue and posterior acoustic enhancement. B) The abscess is outlined in yellow and the posterior acoustic enhancement is noted.
Complex breast abscess. In this clip, the features of a loculated breast abscess containing echogenic purulent material are noted. Example of imaging with a linear high-frequency transducer.
Loculated breast abscess, curvilinear. In this clip, a large, loculated breast abscess and its features are noted. Example of imaging with a lower-frequency curvilinear transducer to better appreciate the extent of this large abscess.
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