Condition
Idiopathic granulomatous mastitis
A benign but long-lasting inflammatory condition of the breast. The word “idiopathic” in the name means the cause is not precisely known. The hardest part of it is that both on examination and on imaging it can mimic breast cancer — which is why the diagnosis usually requires a biopsy.
A research subject
The diagnosis of this condition is one of the surgeon's research subjects. His work on quadrant assessment of the breast and the role of strain elastography in diagnosing granulomatous mastitis has been published in international journals; he has also presented on the topic at the ASVXMA regional conference in Ganja. List of publications.
Who it affects
Mainly women of childbearing age, often within a few years of the last pregnancy or period of breastfeeding. It can nevertheless arise without any direct connection to breastfeeding.
Symptoms
- A firm, painful mass in the breast — usually on one side
- Redness of the skin and increased warmth
- Swelling and pain that increases on touch
- Wounds that open on the skin and discharge pus (fistula formation)
- Enlarged lymph nodes in the axilla
- A course that does not fully settle after antibiotics and keeps recurring
It can be confused with cancer
A firm mass, skin retraction and enlarged axillary nodes can be seen both in this inflammatory condition and in breast cancer. This is not written to alarm anyone — it explains why a biopsy is needed. Starting treatment before the diagnosis is settled is not the right approach.
Diagnosis
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Clinical examination
When the symptom started, the history of pregnancy and breastfeeding, and any previous antibiotic courses are established.
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Imaging
Ultrasound is the first choice. Elastography can add information about the stiffness of the tissue. Mammography and MRI are used where needed.
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Biopsy
The key step in confirming the diagnosis. Pathological examination both excludes cancer and establishes the character of the inflammation.
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Excluding other causes
Tuberculosis, fungal infections and some systemic diseases can produce a similar picture. The diagnosis of “idiopathic” disease is made only once these have been excluded.
Treatment
Treatment is individualised and often requires patience. The course of the disease fluctuates — periods of improvement and flare-ups can alternate.
- Observation — in mild cases the condition can regress on its own over time
- Steroid treatment — to reduce the inflammation, under medical supervision
- Immunosuppressive treatment — where the response to steroids is insufficient
- Drainage of an abscess — where there is a collection of pus
- Surgery — in selected cases, as limited excision
Wide surgical excision is avoided as far as possible, because it affects the shape of the breast and does not always prevent recurrence. Antibiotics help only where there is a superimposed infection — the condition itself is not a bacterial infection.
What to expect
This condition is benign and does not turn into cancer. But treatment can be measured in months and recurrence is possible. Patient follow-up and sticking to the treatment plan are the most important factors. Because the individual course varies so much, quoting a general timescale would be misleading.
Do not delay if you have
- Severe redness and swelling with a high fever
- A rapidly enlarging painful mass
- A wound that opens on the skin and discharges pus
- Feeling generally unwell, with shivering
For general emergencies, call 103.
Frequently asked questions
Is granulomatous mastitis cancer?
No. It is a benign inflammatory condition and does not turn into cancer. But because it can mimic cancer on imaging and on examination, confirming the diagnosis with a biopsy is important.
I took antibiotics and it did not clear — why?
Idiopathic granulomatous mastitis is not a bacterial infection, so it may not respond fully to antibiotics. Antibiotics help only where there is an additional superimposed infection. A lack of response is one of the signs that points towards this diagnosis.
Do I definitely need an operation?
No. In many cases treatment is medical, with observation. Surgery is considered in selected cases and on a limited scale. Wide excision is avoided as far as possible.
Can this condition come back?
Yes, recurrence is possible. That is why follow-up for a period is advised even after treatment is complete.
Does it prevent breastfeeding?
That depends on how extensive the disease is and on the treatment being used. An answer for your situation will be given at the consultation — a general rule would not be appropriate.
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