What causes a lump on the areola

A lump on the areola, or area around the nipple, can occur in both males and females. A lump can be a local infection that may or may not be the result of inflammation of the breast.

Although this condition is possible in males, researchers suggest that more than 95% of people with a lump on the areola are females.

In females, there are two different types of lumps on the areola. These are nonpuerperal subareolar abscesses, which occur in a person who is not breastfeeding, and puerperal abscesses, which occur in women who are breastfeeding.

In this article, we review the causes, symptoms, and treatment options for a lump on the areola.

Causes

Breastfeeding may cause lumps to develop on the areolas.

The most common cause of breast infections is breastfeeding.

Inflammation of the breasts during breastfeeding can affect between 2% to 3% of lactating women, and 5% to 11% of these women may develop an abscess.

Males and females who are not lactating may also develop a lump on the areola. These abscesses may occur in people across a wide range of ages.

Non-lactational breast abscesses seem to have links with smoking and diabetes.

Also, researchers have shown that people who are obese and black people may have a higher incidence of breast abscesses than others.

Individuals who have nipple piercings can develop lumps on the areola as well.

The most common bacteria that causes breast abscesses in lactating women are Staphylococcus aureus (S. aureus) and Streptococcus species.

Doctors are noticing that a specific strain of S. aureus that is resistant to methicillin antibiotics is sometimes also found in lumps on the areola.

Methicillin-resistant S. aureus (MRSA) infections are more difficult to treat and require different antibiotics.

Bacteria that tend to cause breast abscesses in males and non-lactating females are usually a mix of S.s aureus, Streptococcus species, and anaerobic bacteria.

Pictures

Breast cancer and inverted nipple

Image credit: Hic et nunc, 2005.

Breast cancer

Image credit: Bakerstmd, 2015.

Subareolar breast abscess

Image credit: Jhfdsskl, 2007.

Subareolar breast abscess

Image credit: Tiwari, P., & Tiwari, M., Sch. J. App. Med. Sci., 2013.

Subareolar breast abscess

Image credit: Tiwari, P., & Tiwari, M., Sch. J. App. Med. Sci., 2013.

Symptoms

A person with a lump on the areola may complain of the following symptoms:

breast pain

redness in the area

warmth to the touch

fluid accumulation at the site of the lump

People may also report fever, nausea, vomiting, and fluid drainage from the nipple or site of redness.

Young people of any sex who are not lactating tend to report more breast pain than those who are older.

About 15% to 20% of people with lumps on the areola will have discharge draining from the nipple. The fluid that drains from a lump on the areola of a younger person will appear thinner, whereas an older person may have a thicker discharge.

Doctors report that lumps on the areola in females who are not lactating and males recur more often than lumps in lactating women.

Doctors can request an ultrasound of the breast or a mammogram to gain more information on the size, depth, and location of the abscess.

Different types of nipples
The areola forms part of the nipple. There are many different types of nipple. Learn more about them here.
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Treatment

When doctors diagnose a lump on the areola, they will cut and drain out the fluid from the lump. They may take a biopsy of the lump to rule out breast cancer.

People may start antibiotic treatment if the doctor is unable to perform the drainage immediately.

Doctors may prescribe the following antibiotics for lumps on the areola:

nafcillin

ampicillin/sulbactam

amoxicillin/clavulanic acid

doxycycline

trimethoprim/sulfamethoxazole

clindamycin

vancomycin

If the doctor can identify the bacteria present in a sample of the fluid they drain from the lump, they can prescribe an antibiotic that will target those specific bacteria.

Taking a sample of the fluid is important for people who have recurring abscesses because these lumps tend to have a mixture of bacteria, including anaerobic bacteria, as the cause.

Doctors will consider which antibiotics are safe to give to breastfeeding women with lumps on the areola. Women are commonly encouraged to continue breastfeeding.

If someone has a large lump or signs of severe infection, the doctor may admit them to the hospital. These larger lumps require cutting and drainage in the operating room and treatment with intravenous antibiotics.

Care and prevention

A doctor may recommend treatment options such as NSAIDs.

Once a doctor drains the fluid from the lump, a person should no longer feel pain at the site. However, some people will still need painkillers after drainage. Doctors may sometimes suggest narcotics and nonsteroidal anti-inflammatory drugs (NSAIDs) to reduce pain.

If a person is still experiencing inflammation at the site, they can apply a warm compress and moisturizer to prevent cracking of the areola.

People with nipple piercings should make sure they know how to keep the area clean correctly.

Breastfeeding women can consult a lactation nurse to find out how to prevent swelling of the breasts.

Lumps on the areola in breastfeeding women tend to respond well to treatment and are less likely to recur if people manage them appropriately with drainage and antibiotics.

Recurrence rates are high in people who are not breastfeeding. Doctors do not have standardized guidelines for treating lumps on the areola, and this may be a cause of recurrence in some people.

A person with a lump on the areola can consult a team of professionals, including a radiologist, general surgeon, infectious disease specialist, pharmacist, and lactation nurse, if appropriate.

Consulting a multi-professional team can reduce healthcare costs, improve recurrence rates, and reduce the need for unnecessary operations.

Complications

Fistulas are a complication of lumps on the areola that occur in as many as one-third of people.

A fistula is a tract that forms between the milk duct or the opening of the abscess in the breast and the areola. If this occurs, a doctor will notice a raised, crusted lesion on the nipple during a physical examination.

Fistulas can also occur in men.

When to see a doctor

People should consult their doctors if they notice a lump on the breast or nipple or experience any fluid leaking from the nipple.

Doctors will examine the lump and recommend medical imaging to rule out breast cancer, especially in non-lactating people or any sex.

Women who are breastfeeding also need to see their doctors if a lump forms on the areola. A lactation nurse can help a woman prevent future abscesses and coach her to continue breastfeeding or using a breast pump to take the milk from the affected breast.

Any lump that has links with symptoms of severe infection requires hospitalization.

Doctors will also check for fistulas if a person has recurring lumps on the areola.

Takeaway

People who notice a lump on the areola should consult a doctor. With a quick diagnosis, the doctor can start the treatment early. Treatment involves draining the lump and antibiotic therapy.

Women who are breastfeeding are more likely to have lumps on the areola, but both males and females who are not lactating may also develop these abscesses.

Smoking and diabetes seem to have links to lumps on the areola. Obese and black people may also have increased incidence rates.

These painful lumps can recur in some people. Recurrence rates are high in females who are not breastfeeding and in males.

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