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chronic retroareola abscess
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chronic retroareola abscess

Has anyone experiecned this issue.  It is sometimes called a subareola abscess.  This is a chronic condition- I have had 3 surgeries to removed the abscess because of the pain associated with it.  It is back again and my last surgery was in November.  I quit smoking because that is what my one doctor to me the was the ONLY cause and that is I quit smoking it will stop them from returning 100% of the time.  Now I do realize that it takes awhile to clear the smoke yuck out of my system but I am now contemplating removal of the entire nipple/areola area.  Doctor explained that I am in a catch 22 situation- surgery is the only way to get rid of it  (draining will not help because it fills quickly) but the more surgeries the more trama to the area and the less healing power I have....ok so can anyone talk to me about a similar issue???????
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so I am not sure if I am getting no responses because people have no info or if ya all are upset because I posted this question under the breast cancer section.  I am sorry for that- I know I do not have cancer but I couldn't find a general breast health section???? Thanks so much..just not sure where else to turn.  I know there are way worse issue in the the world then this....thanks for any info or opinions you have
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962875_tn?1314213636
Hi,

It is fine to post your question here.  It sometimes takes a while to get an answer, first because this forum is handled by volunteers, and second because some of us pick to answer just those questions that we know most about, or have good information available to share. However,  our community leader is extremely knowledgeable and usually answers any questions that have not been handled, plus adds additional information to others.

Give it a little longer, and I bet someone will respond with relevant information or experience.  There is also a BC Expert forum where you could  post your question  (although they only take a limited number of questions per day, so keep trying if you decide to go that route).

Sorry  I don't have any answers for you, but wanted you to know that we care and do try to help with all sorts of breast issues.

Best wishes...
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Thanks so much bluebutterfly.  
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962875_tn?1314213636
Still no answer, I see.  (Maybe everyone last night saw our names at the side and thought your question had been taken care of...) Sorry!

You could try the Expert forum, but maybe change your question a little, to ask their opinion, from their research and  experience, in regard to the best way of managing this condition , rather than "Has anyone experienced this issue?"  (But be prepared, because many times they  don't venture an opinion, just direct you back to "your treating physicians who have actually examined you and have acces to all  relevant medical information.")

Good luck!
bb
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587083_tn?1327123862
Hi,
Like BB I truly want to help you,but I am afraid that I don't know much about your problem with this recurrent infection.
The only suggestion I can make, is to forget about this thread and try to post your question anew.
Our Community leader "Japdip" who is very knowledgeable about almost all breast problems, will hopefully respond to you and give you some advice.
So sorry for not being able to help you!
I wish you all the best...
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Thanks so much zouzi!
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739091_tn?1300669627
From what I've read, it's mastitis. See below from wikipedia....

Mastitis
From Wikipedia, the free encyclopedia
Jump to: navigation, search
Mastitis

Mastitis is the inflammation of breast tissue.[1] S. aureus is the most common etiological organism responsible, but S. epidermidis and streptococci are occasionally isolated as well.

Terminology
Popular usage of the term mastitis varies by geographic region. Outside the US it is commonly used for puerperal and nonpuerperal cases, in the US the term nonpuerperal mastitis is rarely used and alternative names such as duct ectasia, SUBAREOLAR ABSCESS and plasma cell mastitis are more frequently used.

Chronic cystic mastitis is a different (older) name for fibrocystic disease.

American usage: mastitis usually refers to puerperal (occurring to breastfeeding mothers) mastitis with symptoms of systemic infection. Lighter cases of puerperal mastitis are often called breast engorgement.

In this wikipedia article mastitis is used in the original sense of the definition as inflammation of the breast with additional qualifiers where appropriate.

[edit] Types
It is called puerperal mastitis when it occurs in lactating mothers and non-puerperal otherwise. Mastitis can occur in men, albeit rarely. Inflammatory breast cancer has symptoms very similar to mastitis and must be ruled out.

The popular misconception that mastitis in humans is an infection is highly misleading and in many cases incorrect. Infections play only a minor role in the pathogenesis of both puerperal and nonpuerperal mastitis in humans and many cases of mastitis are completely aseptic under normal hygienic conditions. Infection as primary cause of mastitis is presumed to be more prevalent in veterinary mastitis and poor hygienic conditions.[citation needed]

The symptoms are similar for puerperal and nonpuerperal mastitis but predisposing factors and treatment can be very different.

[edit] Puerperal
Puerperal mastitis is the inflammation of breast in connection with pregnancy, breastfeeding or weaning. It is caused by blocked milk ducts or milk excess. It is relatively common, estimates range depending on methodology between 5-33%. However only about 0.4-0.5% of breastfeeding mothers develop an abscess.

[edit] Nonpuerperal
The term nonpuerperal mastitis describes inflammatory lesions of the breast occurring unrelated to pregnancy and breastfeeding. This article includes description of mastitis as well as various kinds of mammary abscesses. Skin related conditions like dermatitis and foliculitis (folliculitis) are a separate entity.

Names for non-puerperal mastitis are not used very consistently and include Mastitis, Subareolar Abscess, Duct Ectasia, Periductal Inflammation, Zuska's Disease and others.

[edit] Breast cancer
Breast cancer may coincide with or mimic symptoms of mastitis. Only full resolution of symptoms and careful examination are sufficient to exclude the diagnosis of breast cancer.

Lifetime risk for breast cancer is significantly reduced for women who were pregnant and breastfeeding. Mastitis episodes do not appear to influence lifetime risk of breast cancer.

Mastitis does however cause great difficulties in diagnosis of breast cancer and delayed diagnosis and treatment can result in worse outcome.

Breast cancer may coincide with mastitis or develop shortly afterwards. All suspicious symptoms that do not completely disappear within 5 weeks must be investigated.

Breast cancer incidence during pregnancy and lactation is assumed to be the same as in controls. Course and prognosis are also very similar to age matched controls.[3][4] However diagnosis during lactation is particularly problematic, often leading to delayed diagnosis and treatment.

Some data suggests that noninflammatory breast cancer incidence is increased within a year following episodes of nonpuerperal mastitis and special care is required for followup cancer prevention screening.[5] So far only data from short term observation is available and total risk increase can not be judged. Because of the very short time between presentation of mastitis and breast cancer in this study it is considered very unlikely that the inflammation had any substantial role in carcinogenesis, rather it would appear that some precancerous lesions may increase the risk of inflammation (hyperplasia causing duct obstruction, hypersensitivity to cytokines or hormones) or the lesions may have common predisposing factors.

A very serious type of breast cancer called inflammatory breast cancer presents with similar symptoms as mastitis (both puerperal and nonpuerperal). It is the most aggressive type of breast cancer with the highest mortality rate. The inflammatory phenotype of IBC is thought to be mostly caused by invasion and blocking of dermal lymphatics, however it was recently shown that NF kappaB target genes activation may significantly contribute to the inflammatory phenotype. Case reports show that inflammatory breast cancer symptoms can flare up following injury or inflammation making it even more likely to be mistaken for mastitis. Symptoms are also known to partially respond to progesterone and antibiotics, reaction to other common medications can not be ruled out at this point.
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739091_tn?1300669627
From Pubmed..

Chronic recurrent subareolar abscess formation

Abstract
Chronic recurrent subareolar abcedation. Chronic recurrent subareolar breast abscess is an unfrequent disease of the breast. The surgeon must be acquainted with the syndrome, otherwise it may lead to unnecessary mutilation. The condition usually develops in younger women, but has no relation with lactation. Inverted nipples are a constant finding. The evolution is a chronical one, with acute exacerbations. Small abscesses rupture spontaneously or necessitate surgical drainage or disappear with antibiotics. The basic pathological factor is squamous metaplasia of the lining epithelium of the milksinus. The ampulla is plugged with keratine debris and leads to abscess formation in the retroareolar space. Chronic recurrent subareolar abscesses have to be distinguished from commedomastitis, also called ductal ectasia. The treatment is different for acute and chronical forms. In the acute form antibiotics are administered and eventually incision and drainage of the abscess are performed. In the chronical form excision of the diseased milksinus and fibrotic tissue with the nipple is mandatory. We do not hesitate to excise the majority of the milksinuses.

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962875_tn?1314213636
I have already shared this info with you in a PM, but I'm going to post it here, so that someone who might read your thread in a search of the archives in the future will also have access to it, in addition to all of the good information SueYoung55 provided.

Chronic recurrent subareolar breast abscess: incidence and treatment
F. N. L. Versluijs, R. M. H. Roumen, R. J. A. Goris  
Department of Surgery, University Hospital, Nijmegen, The Netherlands
St Joseph Hospital, Veldhoven, The Netherlands


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. ( 2000 British Journal of Surgery Society Ltd )
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A related discussion, recurrent subareolar breast abscess treatment was started.
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I know this is an old post but was wondering if this conversation was ever continued since I seem to be in the same situation as the subject above and terrified mine may reoccur after surgery and do not want to lose my nipple if this doesn't heal correctly
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962875_tn?1314213636
Welcome to our community.

This thread ended with my post above.

I hope the information was of some help to you.

Best wishes,
bluebutterfly
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Avatar_f_tn
I have been having reccurent abcesses around my nipple that have to be cut open and drained. Did this about 5 times since last year. Then the doctor said I had Zuska's disease and I would need surgery to remove the ducts that keep getting infected. As we speak, I have an abcess (abscess) forming that will have to be drained. Has anyone had the surgery to remove ducts? My doctor says smoking may be a cause.  I've heard of people who don't smoke who get this so smoking can't be the #1 cause.  He also said caffine and chocolate lead to cyst formations. Is there any cure?!
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962875_tn?1314213636
Sorry you are having such a difficult time! :-(

As indicated in the article I posted above, primary treatment is incision and drainage, but if the affected duct(s) are not removed, the SBA is destined to result in chronic recurrent absesses, as you have already experienced:

"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." ( 2000 British Journal of Surgery Society Ltd )

Your doctor has given you the correct treatment advice, but if you still have doubts, you could request a second opinion..

Best wishes,
bluebutterfly
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