A systematic surgical approach for the treatment of idiopathic granulomatous mastitis: a case series

Abstract

Background: Surgical resection can be performed for idiopathic granulomatous mastitis (IGM), but recurrence and tissue defects remain issues. Here we report our 6-year experience with a four-pattern surgical approach for IGM that involves the use of a random breast dermo-glandular flap (BDGF).Methods: Sixty-eight consecutive patients with IGM were prospectively enrolled from 01/2012 and 03/2017. Based on the extent, shape, and location of the lesions, four different patterns of surgery based on BDGF were used to remove the lesion and repair the defect. Operative data (time, blood loss, and intraoperative complications), primary healing time, recurrence, and patient-reported outcomes (cosmetic outcome, and improvement in dressing change and bathing) at 2 years were evaluated.Results: Patients' median age was 35 (range, 22-55) years. Duration of IGM was 3-22 months, with a median lesion size of 3.5 (range, 0.9-9.1) cm. The operative time was significantly longer, and blood loss was more important with the increasing lesion size (both P<0.05). No significant intraoperative complications occurred. All wounds healed by primary intention. IGM relapsed in three patients (3/68, 4.4%); they were treated successfully with a second operation. The self-evaluated cosmetic outcome was "much better" in 45 patients (66.2%), "a little better" in 18 (26.5%), and "same or worse" in five (7.3%). The self-evaluated improvement in dressing change and bathing was "improved a lot" in 51 patients (75.0%), "improved a little" in 11 (16.2%), and "not improved or getting worse" in six (8.8%). Conclusions:The BDGF-based systematic four-pattern surgical approach is effective in the treatment of IGM. Recurrence rate is low, there are no complications, and the cosmetic results and improvement in dressing change and bathing are generally favourable.

Management of idiopathic granulomatous mastitis in lactation: case report and review of the literature

“…A large study of IGM that investigated 206 individuals in Iran recommends corticosteroids as first line treatment for this disease [ 3 ]. There are reports of surgical management with improved cosmetic outcomes and minimal complications, including mastectomy with immediate reconstruction, but there is also report of surgery causing increased inflammatory reaction and fistulazation [ 7 , 10 , 29 ]. While anti-tuberculosis agents such as rifampin have been utilized, they also have been associated with rebound inflammation [ 30 , 31 ].…”

Local Steroid Treatment: An Effective Procedure for Idiopathic Granulomatous Mastitis, Including Complicated Cases

“…Moreover, resection in IGM can cause undesired cosmetic results [8,10,28]. Due to high recurrence rates and poor cosmetic results, patients may require multiple operations and some of these patients even require mastectomy [29]. These cosmetic problems also lead to psychological problems [29,30].…”

“…Due to high recurrence rates and poor cosmetic results, patients may require multiple operations and some of these patients even require mastectomy [29]. These cosmetic problems also lead to psychological problems [29,30]. The probability of cosmetic problems in LST is relatively lower.…”

Assertive clinical practice in managing patients with idiopathic granulomatous mastitis: Review of literature

“…There is a trend now toward more minimally invasive surgical intervention such as aspiration for abscesses. Surgical methods vary from wide surgical excision, and mastectomy [ 11 , 20 ].…”