Schematic algorithm for surgical treatment of idiopathic granulomatous mastitis using combined steroids and therapeutic mammoplasty techniques

Introduction Idiopathic granulomatous mastitis (IGM) is a rare, benign, chronic, inflammatory lesion of the breast of unknown etiology. Clinically, it can be mistaken for inflammatory and neoplastic disorders of the breast. Laboratory investigations with culture and sensitivity, PCR for Mycobacterium tuberculosis and core needle biopsy are crucial. Treatment is controversial, but oral steroids are usually started with, followed by surgical resection if there is no complete response. Aim This study discusses the use of therapeutic mammoplasty techniques to excise the mass and preserve breast aesthetic appearance concerning patient satisfaction and recurrence. Patients and methods Fifty IGM patients were included with moderate to large breasts with masses 20-50% of the breast size after failure of medical treatment with prednisolone, or occurrence of therapy-related complications. Preoperative core needle biopsy, smear for Ziehl-Nelseen acid fast staining, and culture and sensitivity test. Mammography and ultrasonography were done. An informed consent was obtained regarding the operative procedure and research. On surgery we excise the inflammatory mass with a rim of normal nonaffected tissues around with most of retroareolar duct system. Patients were followed up for 1 year in regular outpatient visits, where recurrence and patients' satisfaction were assessed. Results The most important postoperative complication was disease recurrence (4%) and deformity (10%). The most common one was minor wound dehiscence (40%). For patient satisfaction, the median mean percent satisfaction score was 74.50%. Conclusion The use of therapeutic mammoplasty in surgical management of IGM has low recurrence rate and high postoperative patient satisfaction.