Twenty-two year experience with recurring subareolar abscess andlactiferous duct fistula treated by a single breast surgeon

Background Recurring subareolar abscess and lactiferous duct fistula are frequently difficult to manage. Methods Personal experience with 67 cases treated during the past 22 years is reviewed. Results There were 38 cases of subareolar abscess and 29 of lactiferous duct fistula. Thirty-three patients had resolution with antibiotics and needle aspiration or with incision and drainage,but 34 patients required definitive duct excision. Eight patients had duct excision through circumareolar incisions, and 5 of these had prolonged healing problems or recurrence within 1 year. Twenty-six patients had duct excision by placing a probe into the duct and radially excising an elliptical area of the nipple and areola like a “slice of pie,” and these all healed primarily (P <0.001). Conclusions Approximately half of the patients with subareolar abscess can be managed medically, but the other half will require definitive duct excision. A radial elliptical incision with primary closure results in excellent cosmesis and low long-term recurrence rates.