Idiopathic Granulomatous Mastitis: Surgery, Treatment, and Reconstruction

Abstract

Idiopathic granulomatous mastitis is a rare inflammatory breast disease that mimics breast diseases such as inflammatory breast carcinoma, infective mastitis, and inflammatory breast disease of known cause. It is a diagnosis made only after excluding other causes, and although the disease is nonmalignant it may be both locally aggressive and recurrent. Definitive treatment may require radical excision and adjunctive treatment with immunosuppressants. Reconstruction following excision of disease has not been previously described. In those patients who undergo reconstruction, both the surgeon and the patient must be aware of complications associated with residual disease, and the potential involvement of donor sites. Treatment should be undertaken as part of a multidisciplinary team including surgeons and physicians with an interest in inflammatory breast disease. We present two patients diagnosed with idiopathic granulomatous mastitis who were referred to our unit for consideration of reconstruction. One patient underwent autologous breast reconstruction and the other contra lateral surgery to achieve symmetry.

Combined Long-Term Steroid and Immunosuppressive Treatment Regimen in Granulomatous Mastitis

“…Wide local excision to obtain disease-free margins or mastectomy for benign disease is a challenging decision both for the surgeon and the patient. Breast reconstruction techniques may be used to improve patient satisfaction [12]. The cosmetic results of the surgery are very poor, and the addition of systemic therapy may prevent surgical intervention for recurrences.…”

Management of idiopathic granulomatous mastitis with observation

“…8,9,[10][11][12][13] Recurrence or residual disease, however, may still occur after mastectomy. 10,11,14 Currently, surgical management has become less prominent in its management and non-surgical M A N U S C R I P T A C C E P T E D ACCEPTED MANUSCRIPT 5 recommendations have become more common including medications (i.e., steroids, methotrexate, azathioprine, tuberculosis medications) or close observation. 8,9,15,16 One study found that patients underwent spontaneous resolution in 14.5 months.…”

Idiopathic Granulomatous Mastitis: A Case Report

“…In the relapsed cases supplementary therapeutic treatment is advised. Taghizadeh et al (2007) and Akcan et al (2006) other appropriate choices are as following: oral steroid therapy with a dose of 16 mg daily for 6 weeks and gradual tapering and surgical approach in the relapsed cases (Azlina et al, 2003;Hirata et al, 2003) waiting and conservative approach with short interval follow-up periods (Lai et al, 2005;Diesing et al, 2004) and finally using Metothrexate and Colchicine in cases resistant to corticotherapy. Diesing et al (2004) and Kim et al (2003) it is essential to ruled out infectious causes in corticotherapy cases and antibiotic treatment should start before administration of oral steroid in abscess cases.…”

“…Reconstruction using prothese has not been advised and it is recommended that tissue reconstruction approaches such as Latismus flap be used (Taghizadeh et al, 2007).…”

“…Other systemic granulomatous diseases such as sarcoidosis, Wegner granulomatosis and tuberculosis are ruled out and standard and specific microbiological tests are done (Taghizadeh et al, 2007).…”