Treatment of Periductal Mastitis

Choi, Kyung Tae; Lee, Nam Hyuk; Kim, Sang Youn

Abstract

Periductal mastitis is an inflammatory disease of uncertain etiology affecting the major breast ducts and has been given a variety of names by different authors. The treatment of this condition varies according to the clinical manifestations and the state of recurrence. Thirty-two cases of periductal mastitis during the period of 5 years from March 1991 to February 1996 were reviewed to investigate the clinical characteristics and to assess the results of different surgical procedures. The mean age of the patients was 41.2 years with a range of 26~64 years. The clinical manifestations included mastalgia (93.8%), abscess (43.8%), palpable mass (37.5%), nipple retraction (34.1%), and nipple discharge (21.9%). Aerobic and anaerobic bacteria were isolated in nine of 16 cultures. Acute inflammatory indurations in 6 patients were treated with antibiotics(cephalosporine combined with metronidazole) alone, and abscesses in 14 were treated by incision and drainage plus antibiotics. Twelve patients with a discrete mass had primary excision of the mass and diseased major ducts under antibiotics cover. Recurrence rates after initial treatment for inflammatory indurations, abscesses, and discrete masses were 66.7%, 50%, and 16.7%, respectively, and the median recurrence rate was 31.3%. Thirteen patients with recurrent diseases were treated by excision of the entire major duct system following appropriate preoperative management including, antibiotics and/or incision and drainage; this resulted in satisfactory healing in all without recurrences. In conclusion, initial treatment for patients with inflammatory indurations or abscesses should be more conservative even though nearly half of such patients eventually may require further surgery. Also, there were several recurrences even after excision of the diseased major duct system. To avoid these recurrences, we suggest that a discrete inflammatory mass that does not respond to antibiotic therapy and any recurrent diseases be treated by excision of the entire major duct system rather than by excision of only the diseased ducts.