Breast Abscess

A breast abscess is a lump in the breast that contains pus. Also known as a breast boil, this condition is usually caused by an infection, and is often experienced by breastfeeding mothers.

Breastfeeding mothers who experience breast abscesses need to get treatment immediately. However, don’t worry, breastfeeding mothers with breast abscesses can still breastfeed their children with the uninfected breast.

Causes of Breast Abscess

Inflammation of the breast tissue (mastitis) that is not treated immediately or is caused by a blockage in the mammary glands, is the main cause of the collection of pus (abscess) in the breast.

Breast infections themselves can occur due to several things, one of which is the entry of bacteria from the baby’s mouth into the milk ducts through cracks in the nipple. Although more common in breastfeeding mothers, women who do not breastfeed and a small number of men can also experience breast abscesses.

There are several factors that increase a person’s risk of suffering from a breast abscess, including:

• Having nipple piercings
• Suffering from diabetes
• Have a smoking habit
• Suffering from HIV/AIDS
• Have had breast surgery in the last 2 months
• Ever had a breast infection?
• Elderly

Breast Abscess Symptoms

A breast abscess looks like a lump under the skin, which feels soft and movable to the touch. However, this lump cannot be felt if the abscess grows deeper in the breast.

Other symptoms experienced by breast abscess sufferers can vary, depending on the severity. Complaints that can arise include:

• Breasts are red, swollen, and painful
• Lumps that don’t go away after breastfeeding
• Discharge of pus from the nipple
• Breast pain causes mothers to be unable to breastfeed their children.
• Breast pain continues to interfere with activities
• Fever for more than 3 days and does not improve despite treatment

When to see a doctor

Breast abscesses are formed due to mastitis that is not treated immediately. Therefore, breastfeeding mothers need to be alert and check with a doctor if they feel a lump in their breast, and if the breast is reddish, painful, and swollen.

Every woman is also advised to do a breast self-examination (SADARI). SADARI is done every 7 days after menstruation. The goal is so that if there is an abnormality in the breast it can be detected early.

Women are also advised to undergo clinical breast examination (SADANIS) by a doctor. SADANIS is recommended every 1-3 years starting at age 20. After age 40, SADANIS needs to be done routinely at least once a year.

SADARI and SADANIS are carried out as a form of anticipation and early examination of breast diseases, especially if there is a history of breast cancer in the family.

Breast Abscess Diagnosis

The doctor will perform a physical examination of the patient’s breasts. Next, the doctor will ask the patient to undergo a breast ultrasound (USG mammae).

The purpose of an ultrasound is to check the depth and location of the infection in the breast, and to determine whether the lump is mastitis, a breast abscess, or a tumor.

The doctor will also take a sample of breast milk or pus from the abscess through an injection, to be examined in the laboratory. From this examination, the doctor can find out the cause of the infection and determine the right type of treatment.

In addition to ultrasound, scans can also be done with mammography and breast biopsy. However, this procedure is only performed if the patient is not a breastfeeding mother. The test aims to ensure that the symptoms experienced are not symptoms of cancer.

Breast Abscess Treatment

To treat breast abscesses in breastfeeding mothers, doctors will prescribe antibiotics, such as cephalexin. Please note, breastfeeding mothers can continue to breastfeed their children even while taking the drug.

Breast abscesses can also occur in women who are not breastfeeding. To treat it, doctors can give antibiotics clindamycin or amoxicillin.

In addition to antibiotic treatment, there are other procedures that can be performed to treat breast abscesses, namely:

• Remove pus with a syringe
• Draining the pus out with the help of a catheter
• Treating breast abscesses with a special procedure called vacuum assisted biopsy

Meanwhile, pain due to breast abscess can be treated by taking paracetamol and compressing the breast with a towel soaked in warm water or ice water.

During the healing period, patients who are breastfeeding need to continue expressing breast milk every 2 hours from the affected breast. This is done to prevent further infection. However, the child should not breastfeed from the affected breast because of the risk of infection.

Patients also need to get plenty of rest, eat nutritious food, drink enough water, and manage stress well. These things aim to speed up the healing of breast abscesses.

Breast Abscess Complications

There are several complications that can occur due to breast abscesses, namely:

• Recurring breast infection
• The emergence of scars or scar tissue
• Breast size shrinks so that it looks unbalanced
• Chronic breast abscess
• Spread of infection to other parts of the body
• The appearance of abnormal ducts in the breast
• Abnormalities in the lymphatic vessels that cause swelling in the arms (lymphedema)

Breast Abscess Prevention

Mastitis is one of the causes of breast abscess. Therefore, it is important to know how to prevent mastitis, especially in breastfeeding mothers, including:

• Always wash your hands before breastfeeding, to avoid the possible spread of bacteria.
• Make sure the nipple and the brownish part around it (areola) are attached perfectly to the baby’s mouth when breastfeeding.
• Breastfeed with both breasts alternately and not in the same breastfeeding position continuously
• Breastfeed regularly and avoid long breaks between feedings.
• Wearing a bra that fits properly and not wearing tight clothing.
• Do not use creams and ointments on the nipples.
• Not using nipple pads for long periods of time
• Drink plenty of water to prevent dehydration.
• Perform SADARI and SADANIS regularly to detect abnormalities in the breasts early.

Koh, A. et al. (2021). Mastitis and Mammary Abscess Management Audit (MAMMA). British Journal of Surgery, 108(9), pp. e286–7.Paty, B. et al. (2019). Bacteriological Profile and Antimicrobial Susceptibility Pattern of Non-lactational Breast Abscess. Journal of the Academy of Clinical Microbiologist, 21(2), pp. 70–3.American Academy of Family Physicians (2020). Mastitis.Kementerian Kesehatan Republik Indonesia (2017). Pengendalian Penyakit Tidak Menular. Deteksi Dini Kanker Payudara dengan SADARI dan SADANIS.National Health Service UK (2020). Health A to Z. Breast AbscessVictoria State Government Australia (2021). Betterhealth Channel. Breastfeeding – Mastitis and Other Nipple and Breast Problem.Mayo Clinic (2020). Diseases & Conditions. Mastitis.Alli, R. WebMD (2020). Breast Infection.Case-Lo, C. Healthline (2021). Subareolar Breast Abscess.Johnson, T. WebMD (2021). Doctor's Breast Exam.Miller, A. Medscape (2021). Breast Abscesses and Masses.