Breast abscesses in men are very rare unless there is a history of immune deficiency. There have been isolated reports of breast abscesses in patients with HIV infection. This study presents four cases of HIV positive homosexual men with inflammatory breast disease treated in this unit over a 6-year period. One patient presented with a tuberculous breast abscess treated by surgical excision and anti-tuberculous chemotherapy. This is the first reported case of tuberculous breast abscess in an HIV positive male presenting as an AIDS defining illness. One patient presented with a peri-areolar abscess due to an anaerobic bacterial infection and two patients presented with a discharging sinus and tender breast lump due to non-specific chronic inflammation. This paper reviews the pattern of presentation, pathology and management of inflammatory breast disease in HIV positive men.