J Korean Surg Soc.  2009 Sep;77(3):153-160. 10.4174/jkss.2009.77.3.153.

Surgical Treatment for Idiopathic Granulomatous Mastitis

• Tae SY
• Lee SW
• Han SU
• Woo HD
• Son DM
• Kim SY
• Kim HC
• Lee MH
• Song OP
• Lim CW

• KMID: 2004213
• DOI: http://doi.org/10.4174/jkss.2009.77.3.153

Abstract

PURPOSE
Idiopathic granulomatous mastitis is a rare benign inflammatory breast disease of an unknown etiology and the optimal treatment remains controversial. The aim of this study is to evaluate the efficacy of surgically complete excision in patients with idiopathic granulomatous mastitis. METHODS: Between March 2005 and November 2008, we treated 14 cases that were diagnosed with idiopathic granulomatous mastitis. Prospectively, we treated the cases with complete surgical excision with or without steroid therapy in all patients. RESULTS: The mean age of the patients was 36 years (range 30 to 53 years). All cases performed were complete excision with or without steroid therapy. The median follow up period was 26 months (range 5 to 50 months) and all cases had no recurrence. 13 patients out of the 14 were satisfied with the cosmesis of the treated breast. CONCLUSION: We conclude that the treatment of choice for idiopathic granulomatous mastitis is surgically complete excision.

Keyword

Idiopathic granulomatous mastitis; Treatment; Complete excision

MeSH Terms

Breast
Breast Diseases
Follow-Up Studies
Granulomatous Mastitis
Humans
Prospective Studies
Recurrence

Figure

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  Fig. 1 Algorithm for management of idiopathic granulomatous mastitis.

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  Fig. 2 Presentation of patient described in case 2, who had steroid therapy already. (A) View of the right breast in an idiopathic granulomatous mastitis with fistula formation. (B) The incision of periareolar and the skin lesion of fistula. (C) View of the specimen that has well demarcated margin.

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  Fig. 3 (A) Ultrasonography before steroid therapy. (B) Ultrasonography after steroid therapy for 4 weeks. The size of lesion diminished 2.1 cm to 1.6 cm.

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  Fig. 4 (A) Ultrasonography of patient in case 5 shows hypoechoic lesion about 2 cm sized. (B) We removed the lesion by mammotome, because the patient did not want surgery. She had recurrence after 9 months at the same position.

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  Fig. 5 (A) Gross photograph showing multiple purulent exudates. Arrow = focal inflammatory change. (B) Characteristic granulomatous inflammation is noted (H&E stain, ×40). (C) Granulomatous inflammation shows central inflammatory exudate and palisading epithelioid cell and multinucleated giant cells (H&E stain, ×100).

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  Fig. 6 Postoperative photogram. This patient practiced quadrantectomy with reconstruction with pectoralis major muscle flap for treatment of idiopathic granulomatous mastitis.

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