Postmenopausal breast abscess.

Eighteen postmenopausal women with breast abscess were treated at Grady Hospital between 1975 and 1978. Breast abscess was remarkable for its characteristic lack of inflammation, as well as its rarity, in this age group (median, 59 years). Only 17% of patients reported fever and/or breast pain. On initial examination, 33% had erythema, warmth, and/or fluctuance. The white blood cell count was greater than 10,000/cu mm in only 14% of patients. (Abscess was not even suspected in 22%, as a breast "mass" was excised for diagnostic frozen section.) The preoperative diagnosis was cancer in 55%. Location was peripheral in 27% and subareolar in 72%, similar to what has been noted in premenopausal women. The rare occurrence of breast abscess in postmenopausal women can be confused with cancer because of the abscess' indolent characteristics. History, physical examination, mammograms, and white blood cell count are equally unhelpful in the diagnosis. Although ideal treatment of abscess is usually incision and drainage, in this age group excision of the total "mass" is sometimes beneficial for diagnosis and prevention of recurrence.