Lactational Abscess
Key Facts
Terminology
Bacterial infection occurring during lactational period
Etiology/Pathogenesis
Skin bacteria can be introduced into breast tissue
Most abscesses are due to Staphylococcus
Streptococcal infections are less common
Bacterial growth is supported by presence of milk
Clinical Issues
Breast is focally swollen, painful, and erythematous
Most abscesses resolve with treatment, and breastfeeding can continue
Macroscopic Features
Most specimens will be from an incision and drainage procedure and will consist of multiple fragments
Microscopic Pathology
Acute inflammatory infiltrate in breast tissue; tissue necrosis may be present
Top Differential Diagnoses
Inflammatory breast carcinoma
Squamous metaplasia of lactiferous ducts (“recurrent subareolar abscess”)
Other bacterial infections
Fungal infections
Parasitic infections
Granulomatous lobular mastitis
 Abscesses occurring during lactation are due to the introduction of skin bacteria into the breast via breaks in the nipple skin. An acute inflammatory infiltrate obscures the normal breast tissue. |
 Numerous polymorphonuclear leukocytes and tissue necrosis are present. Special stains may show the causative bacteria. The most commonly cultured bacteria is Staphylococcus aureus. |
TERMINOLOGY
Definitions
Bacterial infection occurring during lactational period
ETIOLOGY/PATHOGENESIS
Etiology/Pathogenesis
Breaks in nipple skin during breastfeeding are common
Skin bacteria can be introduced into breast tissue
Most abscesses are due to Staphylococcus species
Streptococcal infections are less common
Bacterial growth is supported by presence of milk
CLINICAL ISSUES
Presentation
Breast is focally swollen, painful, and erythematous
Treatment
Breastfeeding or mechanical expression of milk should continue
Antibiotics targeting Staphylococcus species are effective in most cases
In rare cases, surgical incision and drainage may be necessary
Prognosis
Most abscesses resolve with treatment, and breastfeeding can continue
MACROSCOPIC FEATURES
Macroscopic Appearance
Most specimens will be from an incision and drainage procedure and will consist of multiple small fragments
MICROSCOPIC PATHOLOGY
Histologic Features
Acute inflammatory infiltrate in breast tissue; tissue necrosis may be present
Special stains for microorganisms may reveal bacterial forms
DIFFERENTIAL DIAGNOSIS
Inflammatory Breast Carcinoma
Obstruction of dermal lymphatics by tumor cells causes erythema and edema resulting in marked swelling of breast
No true inflammation is present
Inflammatory breast carcinoma should be suspected in women presenting with swollen red breast, particularly if outside lactational period
Inflammatory carcinoma presenting during lactation is very rare and difficult to diagnose
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