Subareolar Abscess

A subareolar abscess is an infected collection of fluid beneath your areola (the darker area of skin around your nipple). It’s a type of breast abscess and a possible complication of mastitis. You might notice a swollen lump forming under your skin. The lump may hurt if you press on it, and pus may come out.

You should always see a healthcare provider if you have symptoms of a subareolar abscess. Don’t wait or try to treat it at home. Providers drain the fluid and give you medicine to clear up the infection. 

Symptoms of a subareolar abscess

Subareolar abscess symptoms include:

• Pain (often the first symptom)
• A noticeable lump under your skin
• Swelling around the lump
• Skin changes around the lump (redness/discoloration, feeling warm to the touch)
• Nipple that points inward
• Pus leaking out

You may also have flu-like symptoms, including fatigue, fever or chills.

What causes a subareolar abscess?

A subareolar abscess is a complication of mastitis. Let’s take a closer look at what that means.

Mastitis is the medical term for inflammation in your breast tissue. Sometimes, the inflammation leads to a bacterial infection (bacterial mastitis). Treatment can stop the problem in its tracks. But without treatment, the infection can get worse. Fluid (pus and milk) starts building up in one spot under your skin. This fluid collection is called an abscess.

We’re talking about subareolar abscesses in this article, but it’s important to know that fluid can build up anywhere in your breast — not just beneath your areola. “Breast abscess” is the medical term for a fluid collection in your breast.

Risk factors

Most people who develop a subareolar abscess are breastfeeding. Other things that can raise your risk for this type of infection include:

• Smoking
• Recently getting a nipple piercing
• Being born with an inverted nipple

Complications of this condition

A subareolar abscess that’s not treated — or that comes back after treatment — can lead to a milk fistula. This is an abnormal passageway that carries milk from a duct to your skin’s surface. A fistula causes milk to leak out somewhere else on your breast — not at your nipple, where it should come out.

Rarely, a breast abscess can lead to a life-threatening complication called sepsis. Go to the emergency room right away if you notice any signs of sepsis, including:

• Chills
• Confusion
• Fast heart rate
• Fever
• Shortness of breath

How doctors diagnose this condition

To diagnose a subareolar abscess, your healthcare provider will:

• Ask you about your symptoms and when they started
• Do a physical exam
• Do imaging tests — typically, an ultrasound and, possibly, a mammogram
• Collect a sample of fluid from the abscess to test in a lab

Your provider may recommend other tests as needed to diagnose or rule out other possible conditions.

How to treat a subareolar abscess

Subareolar abscess treatment typically involves:

• Antibiotics. Your provider will choose an antibiotic appropriate for your symptoms and the type of bacteria that’s responsible. Trimethoprim-sulfamethoxazole is commonly the first-line choice for breast abscesses. You’ll likely take pills by mouth for 10 to 14 days.
• Abscess drainage. Your provider will inject a local anesthetic to numb the area around the abscess. Then, they’ll either insert a needle or make a tiny cut (incision) in the lump to allow the fluid to drain. This process helps your provider both diagnose and treat the abscess.

Your provider will tell you how to care for the affected skin at home. They may tell you to “pack the wound.” This involves filling the now cleaned-out space with gauze. This allows the abscess cavity to heal from inside out. It also lowers the risk of another abscess forming.

How can I lower my risk of a subareolar abscess?

Smoking is one of the strongest risk factors for breast abscesses. If you smoke, talk to your provider about ways to quit.

You can also lower your risk of a breast abscess by:

• Seeking good lactation support, including help with latching
• Avoiding oversupply by feeding/pumping based on your infant’s current needs
• Avoiding rapid changes in how often you pump
• Directly breastfeeding, if possible

What can I expect if I have a subareolar abscess?

Following treatment, your breast will heal over the next few weeks. Be sure to follow your provider’s instructions on how to care for the wound. Your provider will also tell you if you should come back for any follow-ups.

Can I breastfeed while healing?

Ask your provider for guidance tailored to your situation. In general, it’s safe to breastfeed as you heal. You should continue feeding your baby as often as you normally would (no more and no less).

For example, if you were feeding or pumping every three hours prior to the abscess, continue at this frequency. Doing so helps you keep the right amount of milk for your baby’s needs. Pumping too often raises your risk of inflammation and engorgement.

Make sure your provider knows you plan to keep nursing so they can adjust your antibiotics as needed.