An Overview of Subareolar Nipple Abscess

A subareolar nipple abscess is a pus-filled sore found on the breast below the nipple or areola. The areola is the ring of darker (pigmented) skin that circles the nipple.

An abscess forms when bacteria enter the skin, and the immune system sends white blood cells to fight the infection. The area becomes inflamed and swells, forming a pocket of pus—a thick, whitish-yellow fluid made up of degenerating white blood cells, dead/living bacteria, and tissue debris.

A subareolar nipple abscess may cause pain, a small tender lump, and drainage of pus. While more common among younger or middle-aged women who are not breastfeeding, they can also form in men.  

This article discusses the symptoms, causes, diagnosis, and treatment of subareolar nipple abscesses.

Subareolar Nipple Abscess Symptoms

The most common symptoms of a subareolar nipple abscess include:

• A red, painful lump on the nipple or areola
• Warm, tender area of tissue on your nipple or areola
• Pus or discharge emerging from the swollen tissue
• Fever with or without chills
• A general feeling of illness, similar to flu-like symptoms
• Tiredness and fatigue

A subareolar nipple abscess is a skin infection and should be seen by a healthcare provider. If left untreated, a breast abscess can cause a mammary duct fistula (clogged milk duct) or mastitis. It can also cause the nipple to retract or turn inward.

What Causes a Subareola Nipple Abscess?

An abscess occurs when bacteria that normally live on the skin enter the body through a hole in the skin. The areolar glands of the breasts are modified sweat glands that open on the skin's surface. Bacteria can enter through the glands and multiply underneath the skin, blocking the areolar gland.

As the bacteria multiply, the immune system is activated to fight the local infection. White blood cells move into the blocked-up areas. Then, pus forms when white blood cells, dead tissue, and bacteria build up in the abscess pocket.

Possible risk factors for subareolar abscess include:

• Smoking
• Autoimmune disease
• Infection
• Trauma
• Breastfeeding
• Diabetes
• Nipple piercing
• Mastitis
  

How an Areola Abscess is Diagnosed

A subareolar abscess is essentially a "walled off" infection in which the body has contained the bacteria in one place by forming walls around the infected area of tissue.

Breast ultrasound and fine-needle aspiration (FNA) are often used to diagnose subareolar abscesses. The material drained from the abscess is sent to the lab to identify the infectious bacteria to guide antibiotic medication choices. 

Other tests used in diagnosing a subareolar nipple abscess may include:

• Clinical breast exam
• Mammogram
• MRI
• Breast biopsy

Your healthcare provider may recommend further testing depending on what they see on your exam.

Differential Diagnoses

Any painful lump under your nipple or areola should be evaluated by your healthcare provider. Conditions that cause similar symptoms as a subareolar nipple abscess include:

• Mastitis is a generalized inflammation in your breast from a clogged milk duct. There may or may not be an infection (bacteria in the duct) with mastitis. A mastitis infection can sometimes develop into an abscess.  
• Inflammatory breast cancer is a rare form of breast cancer that can also cause blocked ducts and painful swelling/inflammation of the breast tissue. A breast biopsy is the best way to definitively identify cancer.

Treating a Subareolar Nipple Abscess

An abscess on the nipple or areola is commonly treated with a combination of antibiotics and draining the infection. In some cases, surgery may be required.

Antibiotics

Subareolar abscesses usually require antibiotic treatment for four to seven days. Common antibiotics used to treat breast abscesses include:

• Amoxicillin
• Clindamycin
• Doxycycline
• Trimethoprim
• Nafcillin
• Vancomycin

If you are breastfeeding, ensure your healthcare provider is aware so they can choose a different antibiotic if needed.

Drainage

For small abscesses, the treatment of choice is aspiration (drawing out the fluid and pus with a syringe). Aspiration can be done with or without ultrasound guidance.

Somewhat larger abscesses—over 3 centimeters (cm) or roughly 1 inch and a half in diameter—may require the placement of a percutaneous catheter. This is a small tube that is inserted through the skin and into the abscess to allow for the continued drainage of any pus that develops.

Surgery

Some abscesses are more difficult to treat, and a surgical incision and drainage (I&D) may need to be done.

This might be the case if the abscess is larger than 5 centimeters, multiloculated (has several compartments separated from each other, making them difficult to drain), or has been present for a long time.

For persistent severe abscesses, it is sometimes necessary to surgically remove the abscess and the glands in which they occur. However, the abscess may persist or recur in some cases, necessitating further treatment.

Treatment in Men

Subareolar abscesses are not common in men. However, when they do occur, they are often complicated by fistulas (abnormal passageways between the duct and the skin of the areola).

Aggressive treatment with complete excision of the duct is recommended. If not completely removed, these abscesses commonly recur.

Home Remedies

While a subareola nipple abscess requires medical treatment, there are some things you can do at home to ease the discomfort and help it heal.

Keep the area clean and wash your hands before and after touching the area. Avoid pushing, popping, or squeezing the abscess. Doing so can cause the infection to spread.

Apply a warm compress or moist heating pad to the area for 10 to 15 minutes several times a day. This will help the abscess to drain more easily when you go to the doctor.

Over-the-counter (OTC) pain relievers, like Tylenol (acetaminophen) or Advil (ibuprofen) can help to ease the pain.

Summary

Subareolar nipple abscesses can occur in women or men. They are often painful lumps in the area around the nipple. While they are generally easily drained and treated with antibiotics, there are a few very serious medical conditions with similar symptoms. Be sure to have your breast examined by your healthcare provider if you have any symptoms of a breast abscess.

A Word From Verywell

Have any painful lump in your nipple or areola area checked by your healthcare provider to ensure it is not a rare form of breast cancer and to get appropriate treatment. If you have had a subareolar nipple abscess drained, be sure it is noted in your medical record so future mammogram results can be interpreted correctly.