Breast abscess

Breast abscess: A serious complication of mastitis

A breast abscess is a localized collection of pus in the breast tissue. It is a rare but very serious complication that in the overwhelming majority of cases develops on the background of untreated or inadequately treated infectious mastitis. This condition never resolves on its own and always requires medical intervention, usually drainage (evacuation) of the pus cavity. It is important to know its distinguishing features to seek emergency help in time.

How and why does an abscess form?

The chain of events leading to an abscess usually looks like this:

1. Blocked milk duct: It all starts with milk stasis that cannot be cleared.
2. Mastitis: Stagnant milk becomes a nutrient medium for bacteria, leading to inflammation and infection of the breast tissue.
3. Cavity formation: If the infection cannot be stopped with antibiotics and effective breast drainage, the immune system tries to "isolate" the infection focus from the rest of the body. It creates a dense capsule around it, inside which pus accumulates—a mixture of dead bacteria, leukocytes and destroyed tissue. This cavity is the abscess.

Oral antibiotics cannot effectively penetrate this capsule, so treatment requires not only continuation of antibiotic therapy but also mechanical removal of the pus.

How to distinguish an abscess from mastitis?

Symptoms of an abscess are similar to those of mastitis, but there are several key differences that should raise concern:

• Localized and well‑defined "lump": Unlike the diffuse induration in mastitis, with an abscess you can feel a distinct, extremely painful formation.
• Fluctuation: Pressing the formation may feel like there is fluid inside (like a water‑filled ball).
• Lack of improvement despite antibiotics: If you have been taking antibiotics for mastitis for more than 48–72 hours and your condition does not improve (high fever persists, pain does not lessen), this is a strong clue to suspect an abscess.
• Skin changes: The skin over the abscess may appear shiny, stretched, sometimes taking on a bluish tint.

The diagnosis is confirmed by breast ultrasound. Treatment consists of draining the abscess (by needle puncture or a small incision) and continuing the course of antibiotics. It is important to know that in most cases continuing breastfeeding from the affected breast is safe and even necessary for better drainage.