European Journal of Cardiovascular Medicine

Breast abscesses represent localized accumulations of pus within the breast tissue, commonly occurring during lactation due to milk stasis and infection ¹. In contrast, non-lactating breast abscesses are rare clinical entities, most frequently presenting in perimenopausal women and typically occurring in central or subareolar regions ². These abscesses are histopathologically and microbiologically distinct from their puerperal counterparts ³.

The pathogenesis of non-puerperal abscesses often involves squamous metaplasia of the lactiferous ducts (SMOLD), leading to ductal obstruction, periductal inflammation, and abscess formation ⁴. First documented by Zuska et al. in 1951, these lesions frequently manifest as recurrent subareolar abscesses and fistulas ⁵. Non-lactational breast abscesses (NLBA) are often associated with smoking, which induces ductal damage and squamous metaplasia, leading to infection ^6,7. Other risk factors include diabetes mellitus, and immunosuppression, all of which impair immune function and wound healing ^8-10. Socioeconomic factors and poor hygiene may further

contribute by delaying treatment and increasing infection risk ³. Anaemia individuals have been seen to have more propensity of developing breast abscesses ^11,12. Traditionally, management involved incision and drainage, particularly in large, fluctuant abscesses, when minimally invasive techniques are contraindicated or have failed. However, recent advances support less invasive techniques, including USG guided percutaneous aspiration and catheter drainage. Lactiferous duct excision is indicated in cases of chronic or recurrent periareolar abscesses, persistent fistulae, or periductal mastitis, particularly in non-lactating women ¹³.

This study aims to delineate the clinical spectrum, microbiological profile, and therapeutic approaches and their outcomes, in patients presenting with non-lactational breast abscesses.

Study Design and Setting:

The study is a hospital-based cross-sectional observational study conducted in the Department of General Surgery, Assam Medical College and Hospital. The study spans one year (From 1st May, 2024 to 30th April, 2025) and aims to evaluate the clinical spectrum, management strategies, and treatment outcomes in patients diagnosed with non lactational breast abscesses.

Inclusion Criteria:

Patients meeting the following criteria were included in the study:

• All diagnosed cases of non lactational breast abscess above 14 years of age, confirmed through clinical and radiological diagnosis.
• Patients presenting with acute or chronic breast abscesses, irrespective of underlying etiology.
•  Cases with no prior surgical intervention for the abscess at the time of presentation.

Exclusion Criteria:

• Breast abscesses occurring in lactating women.
• Patients with known carcinoma of the breast presenting with abscess.

Data Collection and Analysis;

Twenty patients fitting the inclusion criteria were evaluated based on:

- Age of Presentation

- Association with Risk Factors

- Different Clinical Presentations

- Location in Breast

- Laboratory Investigations (Haemoglobin Count, TLC, Culture and      Sensitivity)

- Radiological Investigation (USG Bilateral Breast with Axilla)

- Treatment Modalities Employed

- Follow Up Result

This study evaluates the clinical and microbiological characteristics, risk factors, and treatment outcomes of non-lactational breast abscesses (NLBA) in women presenting to a tertiary care centre over a one-year period. Unlike lactational abscesses, NLBA are less frequently encountered but pose unique diagnostic and therapeutic challenges. In our study, the majority of cases (85%) occurred between the ages of 30 and 50 years, consistent with existing literature that identifies perimenopausal women as the most commonly affected group ^2,3. A significant proportion of patients had identifiable risk factors. Tobacco use (20%) was the most prevalent, aligning with the established role of smoking in the pathogenesis of NLBA through the promotion of squamous metaplasia of the ductal epithelium and periductal inflammation ⁶. Diabetes mellitus (15%) and immunosuppressive states such as tuberculosis (10%) and HIV infection (5%) were also identified, consistent with previous studies reporting impaired immunity and wound healing as contributory factors ^8-10.

Clinically (supported by Radiological evidence) , most abscesses were located in the central or subareolar regions, in keeping with the known predilection of NLBA for these areas due to ductal involvement ². Laboratory investigations revealed a significant portion (25%) of patients to be anaemic, while, leucocytosis was also found in a large group (45%) of patients, which is consistent with other studies ^11,12,14,15. Microbiological cultures primarily yielded Staphylococcus aureus and MRSA, with occasional gram-negative and anaerobic organisms, reinforcing the need for culture-guided antibiotic therapy. Notably, a subset showed no microbial growth, possibly due to prior antibiotic usage or sampling error, a common finding in abscess studies ³.

Management strategies were individualized based on abscess size and chronicity. USG guided techniques were less frequently performed in our institution due to limited manpower. While incision and drainage remained the cornerstone for large or fluctuant abscesses, minimally invasive approaches such as ultrasound-guided aspiration and catheter drainage were successfully employed in selected cases. This reflects the current shift towards conservative treatment where feasible, as supported by recent guidelines ¹³. Recurrent or chronic subareolar abscesses required duct excision, particularly in patients with fistulous tracts or repeated infections, aligning with the recognized need for surgical intervention in SMOLD-associated disease ^4,5.

On follow up, the lowest recurrence was seen in patients undergoing lactiferous duct excision (0%), while the highest recurrence was observed with those undergoing catheter drainage. This is in line with the existing literature that drainage- either surgical or image guided- is essential for successful resolution of breast abscesses.

Non-lactational breast abscesses, though relatively uncommon, present a distinct clinical entity requiring a high index of suspicion and individualized management strategies. This study highlights the predominance of such abscesses in perimenopausal women, with tobacco use, diabetes mellitus, and immunosuppressive conditions emerging as notable risk factors. Central and subareolar localization was typical, and Staphylococcus aureus, including MRSA strains, was the most commonly isolated pathogen. A significant portion of the patients were found to be anaemic, while a notable proportion of the patients were found to be having leucocytosis, which is a marker of inflammation. In the management of breast abscesses, surgical incision and drainage (I&D) was found to be the most frequently used and effective approach, offering low rates of recurrence. Although ultrasound-guided drainage was not widely practiced due to resource constraints, it showed advantages such as enhanced patient comfort, better cosmetic outcomes, and decreased length of hospitalization. Recurrent or chronic presentations, particularly those associated with ductal pathology, benefit from definitive surgical procedures such as lactiferous duct excision. Early diagnosis, appropriate microbiological evaluation, and tailored treatment protocols are essential to minimize recurrence and optimize patient outcomes.

1.      Dixon JM. Breast infection. BMJ. 2013;347:f3291.

2.      Bharat A, Gao F, Aft RL, Gillanders WE, Eberlein TJ, Margenthaler JA. Predictors of primary breast abscesses and recurrence. World J Surg. 2009;33(12):2582–6.

3.      Gollapalli V, Liao J, Dudakovic A, Sugg SL, Scott-Conner CE, Weigel RJ. Risk factors for development and recurrence of primary breast abscesses. J Am Coll Surg. 2010;211(1):41–8.

4.      Zhang Y, Kleer CG. Nonpuerperal mastitis: an update. Arch Pathol Lab Med. 2016;140(10):1004–9.

5.      Zuska JJ, Crile G Jr, Weaver WB. Fistulas of lactiferous ducts. AMA Arch Surg. 1951;62(5):815–20.

6.      Coulson R, George WD. Smoking and breast sepsis in nonlactating women. Breast. 2010;19(6):410–3.

7.      Townsend CM, Beauchamp RD, Evers BM, Mattox KL, Sabiston DC, editors. Sabiston textbook of surgery: the biological basis of modern surgical practice ; [enhanced digital version included]. 21st edition. St. Louis: Elsevier; 2022. 2147 p.

8.      Elsaie ML, Emam HM, El-Azhary RA. Diabetes mellitus and recurrent breast abscesses: A clinical and bacteriological study. J Clin Diagn Res. 2016;10(8):WC01–WC04.

9.      Sung H, Siegel R, Rosenberg PS, Jemal A. Emerging cancer trends among young adults in the USA: analysis of a population-based cancer registry. Breast Cancer Res Treat. 2011;128(3):869–78.

10.   Aryan O, Alikhassi A, Zamani F, et al. Diagnostic accuracy of sonography for differentiating breast abscess from other inflammatory breast disorders. J Ultrasound Med. 2019;38(4):1003–1010.

11.   Chan WY, Wiseberg-Firtell JA. Surgical treatment of breast abscesses: predictors of outcome. ANZ J Surg. 2013;83(10):739–42.

12.   Amir LH, Forster DA, Lumley J, McLachlan H. Incidence of breast abscess in lactating women: a systematic review. Int Breastfeed J. 2014;9:17. doi:10.1186/s13006-014-0017-0.

13.   Habif DV, Greene AK. Periductal mastitis and recurrent subareolar abscess: the role of surgical management. Ann Plast Surg. 2006;56(4):431–4.

14.   Moran GJ, Krishnadasan A, Gorwitz RJ, Fosheim GE, McDougal LK, Carey RB, et al. Methicillin-resistant S. aureus infections among patients in the emergency department. N Engl J Med. 2006;355(7):666–74.

15.   Branch-Elliman W, Golen TH, Gold HS, Yassa DS, Baldini LM. Risk factors for the development of breast abscess in lactational mastitis. Breastfeed Med. 2013;8(2):169–74.