Ann Surg Treat Res.  2022 Nov;103(5):253-263. 10.4174/astr.2022.103.5.253.

Plastic and reconstructive breast surgery techniques in the surgical treatment of idiopathic granulomatous mastitis: a single-center experience

• Dokcu
• Başçeken Sİ

• KMID: 2534846
• DOI: http://doi.org/10.4174/astr.2022.103.5.253

Abstract

Purpose
Idiopathic granulomatous mastitis (IGM) is a chronic inflammatory breast disease with unknown cause and undefined treatment. Since it has a high recurrence rate, wide excisions are recommended for surgical treatment. This study aims to discuss the selection and outcomes of plastic and reconstructive breast surgery techniques following wide excision.
Methods
This study examines the prospectively recorded surgical outcomes of 18 patients who were diagnosed with IGM between 2020 and 2022. Following histopathological confirmation of all patients’ diagnoses, the most appropriate technique was used in conjunction with wide surgical excision. Preoperative standing drawings were made for all patients and operations were performed by the same surgical team under general anesthesia. All patients were monitored for 6 months for postoperative complications, recurrence, and aesthetic outcomes.
Results
The patients underwent surgery for recurrence (n = 8), recurrent abscess (n = 4), and persistent disease (n = 6), in that order. Patients were treated with dermoglandular flap transposition (n = 6), Wise pattern reduction mammoplasty (n = 3), vertical reduction skin incision (n = 3), inferior pedicle with Wise pattern reduction mammoplasty (n = 4), and free nipple reduction mammoplasty (n = 2) techniques following partial mastectomy. No major complications developed postoperatively. Two patients with recurrence benefited from topical steroid injections.
Conclusion
A wide excision is required to prevent IGM recurrence during surgery. After wide excision, the simplest and most easily applicable plastic and reconstructive breast surgery techniques can yield successful results with acceptable complication and recurrence rates. In technique selection, we recommend an individualized surgical approach for effective patient management.

Keyword

Granulomatous mastitis; Oncoplastic breast surgery; Reduction mammoplasty; Therapeutic mammoplasty

Figure

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  Fig. 1 Algorithm for reconstruction method in patients with idiopathic granulomatous mastitis.

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  Fig. 2 Partial mastectomy with dermoglandular flap (2 patients) and Partial mastectomy with Wise pattern reduction mammoplasty (1 patient). (A) Preoperative drawings of a 26-year-old woman with a left upper-outer quadrant lesion; (B) drawing for hemi-batwing mastopexy, (C) plot for contralateral breast symmetry, (D) deepithelization, (E) specimen, (F) 6 months later. (G) Drawing of a 24-year-old woman with a lesion in the left upper-outer quadrant for preoperative batwing mastopexy; (H) specimen, (I) postoperative outlook. (J) A 35-year-old woman with a lesion near the left nipple preoperative drawings (partial mastectomy with Wise pattern reduction mammoplasty); (K) postoperative view, (L) after 1 month.

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  Fig. 3 Partial mastectomy with Wise pattern reduction mammoplasty and contralateral breast symmetry. (A, B) Preoperative drawings of a 35-year-old woman with a right lower quadrant lesion. (C, D) Right breast lesion removed. (E) Contralateral breast symmetry with periareolar approach. (F, G) Postoperative view. (H) One month later.

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  Fig. 4 Free nipple reduction mammoplasty and inferior pedicle with Wise pattern reduction mammoplasty. (A) Preoperative drawings of a 47-year-old woman with a lesion near the nipple. (B) Scar tissue of the fistulized lesion in the right breast. (C) After the nipple free flap was removed, the lesion in the right breast was removed along with the nipple areolar complex. (D) Nipple free flaps. (E) Specimen. (F) Nipple reconstruction with a free flap. (G) Six months later view. (H) Preoperative drawings of a 40-year-old woman with an upper quadrant lesion. (I) Deepithelized inferior flap and specimen in the right breast. (J) Specimen. (K) View after 4 months.

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  Fig. 5 Postoperative complications. (A) Partial superficial epidermolysis of areola. (B) Three weeks later. (C) Outlook after 6 months. (D) Wound dehiscence. (E) Primary suture closure. (F) View after 3 months.

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