Pathophysiology

Breast abscess may be difficult to distinguish from breast mastitis, a more generalized cellulitis. Due to the compartmentalized structure of the breast, regions of necrosis and avascularity, the abscess may lie deep to the overlying tissues. Typical fluctuance may be difficult to appreciate. The pathophysiology of this entity is not precisely known. However, it has been suggested that it may be due to plugging of the ductal openings by keratin at the junction of squamous cell with cuboid epithelium or due to duct ectasia. Bacterial invasions, more commonly by staphylococcus, leads to abscess development. However, as in mastitis, other microorganisms have also been associated with breast abscess. In one case series, monomicrobial aerobic bacteria were most frequently identified with a significant percentage of proteus mirabilis isolates. Additionally, polymicrobial anaerobic cultures, most frequently Peptostreptococcus spp. and Bacteroides sp., are commonly found in recurrent breast abscesses.10 The most common site for breast abscesses to occur is in the subareolar tissue. These are difficult to treat and have a high incidence of recurrence.

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