PATHOGENESIS-BASED TREATMENT OF RECURRING SUBAREOLAR BREAST ABSCESSES

Background. When a subareolar breast abscess (SEA) is incised and drai ned, an extraordinarily high frequency of recurrence is noted. Methods . To develop a pathogenesis-based treatment plan, 24 women with a tota l of 84 abscesses were monitored. Results. In. nine women SEA was unde r the left areola, under the right, in 7 and in eight the SEA occurred either simultaneously or sequentially under both areolae. In II of 24 patients a chronic lactiferous duct fistula also existed. In four of 24 patients four SBAs were treated with antibiotics alone; all recurre d. In 16 of 24 patients initial treatment was incision and drainage pl us antibiotics; all recurred. When the abscess plus the plugged lactif erous duct was excised, there were no recurrences; however, in four pa tients a new abscess in a different duct occurred, which was treated b y en bloc resection of all subareolar ampullae, without further recurr ence. Patients with a fistulous tract had the fistula, its feeding abs cess, and its plugged lactiferous duct excised, without recurrence. In first time SEA the organism was usually staphylococcus; in recurrence s mixed flora was isolated. Pathologic findings ranged from squamous m etaplasia with keratinization of lactiferous ducts to chronic abscess. Conclusions. The cause of SEA is plugging of lactiferous duct within the nipple by keratin. To prevent recurrence the abscessed ampulla wit h its plugged proximal duct needs excision.