What to Know About Breast Cellulitis
Cellulitis is a bacterial infection of the skin and the tissue underneath. Cellulitis can occur anywhere on the body, but breast cancer treatments (such as surgery and radiation) and complications from treatment (like lymphedema) can increase the risk of infection.
Cellulitis isn’t contagious and it can usually be treated with common antibiotics. But if the infection goes untreated, it can spread quickly and become life-threatening.
Symptoms of breast cellulitis
To treat cellulitis as quickly as possible, it’s important you know what to watch for. Breast cellulitis typically starts with a wound or patch of skin that becomes red or darkened. Other early signs of cellulitis include:
skin that is swollen, warm, or tender to the touch
weeping or discharge from a wound
flu-like symptoms, such as fever or chills
If you notice these symptoms, tell your healthcare provider right away. They can help rule out other skin conditions.
What causes cellulitis?
Cellulitis is most commonly caused by the bacteria Streptococcus pyogenes and Staphylococcus aureus, which naturally live on the skin.
You may be at risk of developing breast cellulitis if:
you have recently had surgery or radiation, since cuts, burns, or other wounds in the breasts can become infected. The risk for infection after surgery is higher for people who have a high body mass index (BMI), a history of smoking, or diabetes with uncontrolled blood sugar.
you have received chemotherapy or another treatment that has weakened your immune system.
you have large breasts. Bacteria tends to grow better under the breast and in skin folds.
Post-operative cellulitis
Having an operation — like a lumpectomy, mastectomy, or breast reconstruction — leaves cuts or wounds in the skin that can become infected. Cellulitis can develop within the first few weeks after surgery for breast cancer.
The lymphedema connection
Lymphedema — the buildup of lymphatic fluid that leads to swelling — is a common side effect of breast cancer surgery and radiation. Having lymphedema increases the risk of developing cellulitis.
Anna Kaltsas, MD is a doctor specializing in infectious complications from cancer and its treatment at Memorial Sloan Kettering Cancer Center. Her team published a study of women with lymphedema who developed cellulitis after breast cancer surgery between 2000 and 2024. Of more than 2,900 patients, about 8% got an infection. Of those, about 40% had recurring infections. Other studies show that fewer than 3% of breast cancer patients without lymphedema develop cellulitis.
Not only does lymphedema raise the risk of getting cellulitis, but getting cellulitis can also raise your risk of developing lymphedema. That risk is lower for those who develop cellulitis immediately after an operation or undergoing chemotherapy or radiation.
“You should have a conversation with your radiation oncologist and breast cancer surgery team about minimizing the risks of lymphedema where possible,” Kaltsas said. “But the risks and benefits have to be weighed in terms of treating the cancer appropriately, especially if it's a higher stage or more aggressive cancer.”
How is cellulitis diagnosed?
Not all changes to the skin are signs of infection. For example, radiation can cause changes to the skin, like hyperpigmentation and skin thickening. Chronic lymphedema can also lead to redness or darkening of the skin.
Doctors and other healthcare professionals usually diagnose cellulitis based on a physical exam. They look for signs of inflammation or infection, like tender skin, low-grade fever, body chills, and weeping or discharge from a healing wound. They may take a swab of the wound to test for bacteria. In serious cases, they may order a blood test to check for signs of bacteria in the bloodstream.
“Sometimes radiation can cause burns and skin disruptions, and it can be difficult to tell. You want your healthcare providers to be looking at your skin and making that call,” Kaltsas says.
Medications for cellulitis
If you’ve been diagnosed with cellulitis, your surgeon, primary care doctor, or oncologist can usually treat the infection. They will likely prescribe an antibiotic depending on which bacteria is causing the infection.
Kaltsas says that penicillin is often the best antibiotic to treat cellulitis. She recommends that anyone who has a penicillin allergy and a surgery scheduled visits an allergist to test their sensitivity before the operation.
If your allergy is confirmed, your doctor will prescribe other antibiotics, which should be equally effective for killing the bacteria that cause skin infections.
Treating recurrent cellulitis
Most people who get cellulitis after an operation tend to only get the infection once. People with lymphedema, meanwhile, are more prone to repeat infections. Having had cellulitis also puts you at higher risk for getting it again, even if it was treated successfully the first time. If your cellulitis is recurrent, meaning it returns often, you may be referred to an infectious disease expert who can help manage it.
Recurrent infections can be more difficult to treat. Your doctor might prescribe you a long-term course of antibiotics to prevent repeat infections.
“Cellulitis is so debilitating to patients’ daily lives — they're trying to move past their breast cancer treatment, their surgeries, and their reconstruction, and feel whole again, and then they keep landing in the hospital, sometimes with potentially life-threatening infections,” Kaltsas says.
For people with recurrent cellulitis, she recommends a “pill-in-pocket” approach — keep an antibiotic on hand so that if you notice early signs of cellulitis you can manage it before it becomes serious.
Complications of cellulitis
Untreated cellulitis can lead to life-threatening complications, such as:
bacteremia: a serious infection in your bloodstream
sepsis: a medical emergency caused by your body’s response to a severe infection
osteomyelitis: a bone infection
necrotizing fasciitis: an infection of tissues below the skin
How can I reduce my risk of cellulitis?
Keep an eye on your skin
Kaltsas recommends examining your skin when it’s not infected, so you know what it looks like when healthy. After a surgery, look at the areas that were affected on a daily basis so that you notice if something changes.
Keep wounds clean
After surgery or radiation, keep your skin clean and moisturized. Keep cuts and wounds clean with warm water and mild soap, use protective ointments, and cover them with sterile bandages.
Consider compression garments
Talk to your health care team about ways to reduce your risk of lymphedema. They may recommend you wear compression sleeves or other garments. The pressure from the fabric can help move fluid away from the affected area and minimize swelling that comes with lymphedema.
Get support from your care team
Try to find a health care team that is familiar with preventing and treating lymphedema and other complications of breast cancer. Some of these complications may be unavoidable, but you’ll want a team that’s skilled at managing your side effects while treating the cancer. Your center’s supportive care team may also be available to help here.