Chronic recurrent subareolar breast abscess: incidence and treatment

Abstract

Abstract Background Chronic recurrent subareolar breast abscesses (SBAs) are a distinct entity of non-puerperal breast abscesses. They are located in the retroareolar or periareolar area and occur as a result of obstruction of the lactiferous ducts by squamous metaplasia. Unfamiliarity with this entity often leads to inadequate treatment, and recurrences frequently appear with extended fistulas. For this reason, the incidence of and the treatment for SBAs were analysed retrospectively. Methods In two clinics all patients with non-puerperal breast abscesses were analysed during a 6-year period. Results Some 98 patients were included (in the same period 35 patients were treated for puerperal breast abscesses). In 85 patients a total of 204 SBAs occurred (the largest study known). The remaining 13 patients had other non-puerperal breast abscesses such as cystic breast disease, inflammatory breast carcinoma and fat necrosis. If treatment of the SBA did not include excising the ductus lactiferus, the recurrence rate was 72 per cent. If the ductus lactiferus was excised, the recurrence rate was 37 per cent. Conclusion If a patient presents with a non-puerperal breast abscess in a subareolar location, the first diagnosis to consider should be (chronic recurrent) SBA. Smoking appears to be an important precipitating factor. In a recurrent SBA most frequently anaerobic micro-organisms are cultured. The primary treatment of SBA may comprise only incision and drainage. However, this should be followed by excision of the affected ductus lactiferus, including a part of the mamilla. If the affected ductus is not sufficiently excised, the SBA is destined to become a problematic chronic recurrent abscess.