I’ve compiled a selection of links to medical articles about Granulomatous Mastitis. This is such a rare disease that there is no universally established treatment protocol. Treatment is by trial and error. What works for one woman may not necessarily work for another. There is a high relapse rate with pharmaceutical therapy and conservative surgical management such as incision and drainage. Treatment options described are anti-inflammatory and immunosuppressive therapy with corticosteroids and/or methotrexate, antibiotics, surgical management, mastectomy and “watch and wait.” Some cases of GM “burn out” on their own after 6 to 24 months. According to the literature, the most definitive treatment with the lowest rate of relapse is a complete mastectomy.
Doctors are equally baffled regarding the causes of Granulomatous Mastitis. A number of specialists believe it is an autoimmune condition, hence treatment with immunosuppressive therapy. There is a correlation between other autoimmune disease and IGM. Some cases have been reportedly caused by bacterial infection, particularly corynebacteria. Some cases may have been caused by trauma to the breast or hormonal imbalances. A few cases may have been linked to psychiatric medication use, particularly antipsychotics and mood stabilizers.
Successful treatment with methotrexate: Methotrexate in the management of granulomatous mastitis, 2003
Granulomatous mastitis is a rare benign inflammatory breast disease that often clinically simulates carcinoma. Surgical resection of the entire lesion has been the main method of treatment but recurrence, infection, sinus formation and delayed wound healing can occur relatively commonly. Corticosteroids are also effective in recurrent or resistant cases but are associated with side-effects and relapse of disease after steroid withdrawal. A low weekly oral dose of methotrexate was used in five resistant cases after surgery plus corticosteroid. All cases achieved remission, withdrawal of corticosteroid without relapse and no methotrexate side-effect.
Summary of three cases, all treated with prednisolone/methotrexate. All long-term treatment, experienced recurrence and/or negative side effects: Rheumatologists and breasts: immunosuppressive therapy for granulomatous mastitis, 2004
Feasibility of surgical management in patients with granulomatous mastitis, 2011
“All of the 18 patients underwent a wide excisional biopsy and had a definitive histopathologic diagnosis of GM. The median follow-up was 36 months (range 6-60 months). Only one patient had a recurrent disease, which was diagnosed at 12 months. GM is a rare breast disease that mimics cancer in terms of clinical findings. Preoperative radiologic diagnosis might be difficult. Complete surgical excision is the treatment of choice.”
The Surgical Management of Granulomatous Mastitis, 2010
Abstract: Granulomatous mastitis is an inflammatory breast condition of unknown etiology. Management remains controversial and treatment algorithms are lacking from the literature. Few resources exist that discuss breast
reconstruction following extirpation. This descriptive case series reviews the clinicopathologic features of granulomatous mastitis.
We describe the surgical management undertaken at our institution including General and Plastic Surgery procedures. Eleven clinical charts and histologic slides of biopsy specimens were reviewed in our health region
between 1992 and 2007. Demographic data, clinical presentation, and radiologic findings were tabulated. Treatment consisted of empirical antibiotics and surgical excision. Procedures performed included incision and drainage
(n 8), excisional biopsy (n 15), partial mastectomy (n 5), partial mastectomy with reduction mammaplasty (n 2), and mastectomy with TRAM flap reconstruction (n 1).
Treatment was successful in all but one case. Multiple surgeries for recurrent lesions were often required to achieve final remission. Following extirpation, we recommend delayed breast reconstruction to monitor for
Granulomatous Mastitis caused by bacterial infection and successfully treated with antibiotics: Cystic Neutrophilic Granulomatous Mastitis: An Underappreciated Pattern Strongly Associated With Gram-Positive Bacilli,2011
Case study of granulomatous mastitis associated with antipsychotic drug use: Idiopathic granulomatous mastitis associated with risperidone-induced hyperprolactinemia,2012
Idiopathic granulomatous mastitis (IGM) is a rare inflammatory breast disease. The etiology and treatment options of IGM remain controversial. Previous case reports have suggested that hyperprolactinemia may be associated with IGM. In the present report, we describe the first case of IGM associated with risperidone-induced hyperprolactinemia.
“Other causes of mammary granulomatous formation must be excluded prior to diagnosis, and microbiological investigation is necessary. Because of an absence of a consensus for an appropriate treatment modality for patients diagnosed with IGM, surgery, steroids, immunosuppressants, and antibiotics have been attempted with varying degrees of success. Recurrence is common in the absence of surgical treatment, and a long-term follow-up is generally essential.”