Granulomatous mastitis in multiparae during pregnancy and lactation

Abstract

The incidence of granulomatous mastitis (GLM) in multiparae as seriously affected the quality of life and breastfeeding of pregnant women after delivery, but the treatment is rarely reported. In this article, the development, healing, and lactation of 13 cases were reported and a retrospective analysis was performed. 10 cases of GLM were treated at the Breast Disease Prevention and Treatment Center of Haidian Maternal & Child Health Hospital of Beijing and 3 cases of GLM were treated in the Breast Department of Weihai Municipal Hospital of Shandong province from February 2017 to May 2019. Among the 13 patients, conservative symptomatic treatment was adopted during pregnancy and lactation: anti-infective therapy consisting of oral cephalosporin antibiotic for patients; ultrasound-guided puncture and drainage of pus or incision and drainage after abscess formation. Observation continued during the sinus tract phase. Postpartum breastfeeding was encouraged, especially on the affected side. In this study, the median healing time was 20 months and the average healing time was 30.4 months in 5 healthy breast lactation cases. In 8 cases of bilateral breast lactation, the median healing time was 30 months and the average healing time was 26.5 months. Linear regression test analysis: whether the affected breast was breast-fed after delivery had no effect on the postpartum wound healing time, P = .792. The wounds of 13 patients healed well after lactation, and none of them recurred since the last follow-up visit. There were no adverse events in all infants. Conservative symptomatic treatment for GLM of multiparous women during pregnancy and lactation and encouraging breastfeeding after delivery have no effect on infant health and the recovery time of patients.

Granulomatous Mastitis Occurring during Pregnancy: A Case Report

“…Repeated antibiotic administration is ineffective and may cause unintended side effects. In addition, psychosocial support for the patient’s burden and breastfeeding support are important because of the physical and emotional factors involved [ 9 , 10 ].…”

Spontaneous, idiopathic granulomatous mastitis in a pregnant patient: A case report and review of the literature

“…Currently, the pathological etiology of IGM is unclear. Associations have been made with endocrine conditions such as hyperprolactinemia [ 10 ] or the hormonal variations of pregnancy [ 11 ], smoking, oral contraceptive pill use, α-1 antitrypsin deficiency [ 12 , 13 ], and ethnicity [ 14 ]. An etiopathogenesis of autoimmunity has received recent focus due to an association of an autoimmune cytokine profile with IGM [ 15 ], the concentrated presence of T cells in lobules destroyed by granulomas [ 16 , 17 ], and the clinical response of IGM to steroid treatment [ 17 ].…”

An Update on Granulomatous Lobular Mastitis: It is Time to Tell the Untold

“…Recent studies conducted over the last 10 years have emphasized that other factors such as genetic factors, smoking, and alpha-1 antitrypsin deficiency may have a role in the pathogenesis of the disease. It remains unclear whether GLM is caused by a single factor or a combination of factors (5,(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21). Autoimmunity is considered the strongest theory in explaining the cause.…”

“…It is widely believed that hormonal changes, secretion, and inflammation occurring during pregnancy, delivery, and breastfeeding contribute to the pathophysiology of the disease, and this could explain why the condition is more prevalent between the ages of 20 and 40 when most pregnancies occur. However, several reports of male cases and a wide age range in women (11-83 years) make it difficult to attribute sole responsibility to pregnancy, delivery, and breastfeeding (3,5,(9)(10)(11)(12)(13)(14).…”