Periductal mastitis

What is periductal mastitis?

Periductal mastitis occurs when the ducts under the nipple become inflamed and infected. It is a benign condition, which can affect women of all ages but is more common in younger women.

Symptoms include:

• the breast becoming tender and hot to the touch
• the skin may appear reddened
• discharge from the nipple, which can be bloody or non-bloody
• an infection in the ducts around the nipple
• a pulled in (inverted) nipple.

If left untreated, on occasion an abscess (collection of pus) or fistula (a tract that develops between a duct and the skin) may also develop.

People who smoke may have an increased risk of being affected by periductal mastitis, because substances in cigarette smoke can damage the ducts behind the nipple. Nipple rings (piercing) can increase the chances of infection and make periductal mastitis more difficult to treat.

How is it diagnosed?

Your GP will refer you to a specialist who can make a definite diagnosis. To do this you will probably have a breast examination, mammogram or ultrasound scan. 

If you have discharge from the nipple this may also be tested, especially if it’s bloodstained, to help confirm the diagnosis. 

Treatment

Some people may not need any treatment for periductal mastitis as it can clear up by itself. It’s important, though, to go back to your GP if you have any new symptoms as it can come back.

Usually antibiotics are given to treat any infection. If you have developed an abscess your specialist may use a fine needle to draw off (aspirate) the pus. This would be done in the clinic using a local anaesthetic.

If you have developed an abscess and/or fistula, your specialist will decide the best way to treat it. This may involve using a fine needle to draw off (aspirate) the pus. It usually takes place in the clinic using a local anaesthetic.

If your periductal mastitis doesn’t clear up after taking antibiotics or if it comes back, you may need to have an operation to remove the affected duct or ducts. Your operation is usually done under a general anaesthetic, and you’ll be in hospital for the day or overnight.

After the operation your nipple may be less sensitive than before.

The operation should solve the problem, but if it comes back more ducts may need to be removed, as finding all the ducts can sometimes be difficult.

Research into periductal mastitis has shown that smoking can slow down the healing process, so if you do smoke it’s advisable for you to stop.

What this means for you

Having periductal mastitis does not increase your risk of breast cancer. However, it’s still important to be breast aware and go back to your GP if you notice any further changes in your breasts.