Short Communication

Retrospective Review of a Case Series of Idiopathic Granulomatous Mastitis Chinese Patients Treated with Ductal Lavage

Shunrong Li1,2#, Jiawei Wang1,2#, Liling Zhu1#, Fengxi Su1,2, Kai Chen1,2* and Erwei Song1,2*
1Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen University, China
2Breast Tumor Center, Sun Yat-sen University, Guangzhou, China
#Contributed Equally

*Corresponding author: Erwei Song, Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat- Sen University, Guangzhou, People’s Republic of China
Kai Chen, Breast Tumor Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China

Published: 07 Mar, 2017
Cite this article as: Li S, Wang J, Zhu L, Su F, Chen K, Song E. Retrospective Review of a Case Series of Idiopathic Granulomatous Mastitis Chinese Patients Treated with Ductal Lavage. Clin Surg. 2017; 2: 1349.

Short Communication

Idiopathic granulomatosis mastitis (IGM) is a rare, chronic benign inflammatory disease of the breast. It was first reported in 1972 by Kessler and Wolloch [1], with the etiology unknown. For nonlactational patients with pathologically diagnosis of IGM, the current treatments include antibiotics and/or corticosteroids [2-6], surgery [6-12], drainage [6], methotrexate [13,14], or observation alone [6,15]. In most of the hospital, surgery is usually the last choice, when the diseases cannot be controlled [3,7,16].Corticosteroids is the major conservative treatment nowadays. However, its long-term use may lead to side effects such as steroid-induced diabetes mellitus (DM), the potential risk of infections, glucose intolerance and cushingoid features [8,13]. We hypothesized that ductal obstruction might be one of the causes of IGM, and we proposed that ductal lavage could be used for treatment of IGM patients. In this retrospective case series study, we reported the efficacy and safety outcomes of the ductal lavage as the first-line treatment for IGM female Chinese patients.


We retrospectively reviewed our database and identified 20 IGM patients that had received ductal lavage as the first-line treatment.
Inclusion criteria
1) 18-65 year’s old female patients
2) Mastitis occurred at least 1 year after the cessation of the last lactation
3) Pathologically diagnosed as IGM
4) Received ductal lavage as first-line treatment
Exclusion criteria
1) Pregnant women or women with breast carcinoma
2) Patients with systemic lupus erythematosus (SLE), rheumatic disorders, or tuberculosis
We reviewed the medical charts and extracted demographic features, the clinical presentations of the IGM and the treatment outcomes. For the ductal lavage, we inserted the infusion cannula (21- 23 G) into 4-5 lactiferous ducts from the nipple under local anesthesia, and pump 10ml irrigation solution (2% Lidocaine 5ml, Triamcinolone acetonide 40 mg, 0.9% saline 10ml and ceftriaxone 1.0 g) into the ducts. The patient returns to the clinic the next day, with the irrigation solution staying in the lactiferous ducts overnight, and receives breast massage. Repeat the infusion and massage procedure every other day, for 2 weeks. We reviewed the charts and information of these patients, and obtained the follow-up information by telephone and face-to-face visit at clinic. Complete response (CR) is defined as the disappearance of palpable mass and all related symptoms (redness, tenderness, etc.). Partial response (PR) was defined as significant relief of symptoms, but does not reach the CR criteria. Stable and progressive diseases (SD/PD) were defined as unchanged and progressive symptoms, respectively, indicating the ineffectiveness of the treatment.


A total of 20 patients were identified as eligible. The median age was 34.5 (15-53) years old. The median (range) size of the mass by palpation was 6.25(1.5-12) cm. There were 12 patients had a history of breast feeding and one of them had lactational mastitis during the breast feeding period with a median follow-up of 5.7 months. There were 9 patients achieved CR. The median (range) months to CR was 1.8 (0.7-6.3) months. These patients did not receive any further treatments. There were 10 patients achieve PR. Among them, two received surgical treatment, and one received steroid treatments. The others did not receive any further treatment. There was one patient who had SD/PD, and received surgical treatment. The procedure of the ductal lavage is safe and painless, without any adverse events.


Idiopathic granulomatous mastitis (IGM) is a rare benign inflammatory disease that mimics carcinoma of the breast [1,8,17]. Because of its unknown etiology and low incidence, the gold standard of treatment has not yet been established whilst surgical resection, corticosteroid, methotrexate or observation alone have been previously proposed. Most of the published studies are case reports or small series [2-17]. Surgical excision of is the most commonly reported treatment [2]. In a study conducted by Hur et al. [6], surgical excision was shown to have short recovery time, high possibility of success (90.3%) and low risk of recurrence (8.7%). However, higher risk of recurrence after surgical excision, 17% to 23% were also reported in the other studies [2,12]. Meanwhile, surgery such as lumpectomy, partial or total mastectomy, may lead to delayed wound healing, the formation of abscesses or fistulae, and poor cosmetic results [3,7,16]. Therefore, more efforts are made to search for conservative treatments. In recent years, many investigators have advocated corticosteroid therapy rather than excision (2-5). Mizrakli T et al. [4] reported that 44 (85.6 %) of 49 patients received the standard treatment dose of steroid (0.5 mg/kg/day), and 40 (81.6 %) patients had a disease-free follow-up period time of 6 months. Therapy with corticosteroids might be an effective and appropriate treatment option for IGM. But it is worth noting that although two of the 49 patients responded well to steroid therapy, NSAIDs were administered because of their developed side effects. The side effects of corticosteroids should not be ignored [8, 13]. Bouton ME et al. [15] suggested IGM is a self-limited disease that will resolve spontaneously without treatment. 27 cases resolved without surgical excision or other medications, the average (range) time for the palpable mass to resolve after presentation of symptoms was 7.4 months (0 to 20). However, it is currently unknown which patients will resolve, when which will have diseases progress, when no treatments were given. Therefore, observation alone should be cautious for these patients, and we should balance the benefit of reducing additional cost and treatment, and the risk of diseases progress, when we used these approach. Also, the quality of life would not be good for patients with no treatments. In our study, The median (range) months to CR was 1.8 (0.7-6.3) months, which suggest the effectiveness of ductal lavage. No adverse event was observed during the therapy. But the longest follow-up time is 15 months, and a longer time of follow-up is need. This retrospective study suggested the efficacy and safety of ductal lavage used as the first-line therapy for non-lactational IGM patients. However, due to its retrospective design, some baseline information was not available. Addtionally, lack of standard procedures for efficacy evaluations and patient follow-up may also bring significant bias during analysis. Therefore, we need a prospective designed study to confirm our results. A prospective, single arm study with more data collected was registered (NCT02794688) and initiated.


  1. Kessler E, Wolloch Y. Granulomatous mastitis: a lesion clinically simulating carcinoma. American journal of clinical pathology. 1972; 58: 642-646.
  2. Bani-Hani KE, Yaghan RJ, Matalka II, Shatnawi NJ. Idiopathic granulomatous mastitis: time to avoid unnecessary mastectomies. The breast journal. 2004; 10: 318-322.
  3. Altintoprak F, Kivilcim T, Yalkin O, Uzunoglu Y, Kahyaoglu Z, Dilek ON. Topical Steroids Are Effective in the Treatment of Idiopathic Granulomatous Mastitis. World J Surg. 2015; 39: 2718-2723.
  4. Mizrakli T, Velidedeoglu M, Yemisen M, Mete B, Kilic F, Yilmaz H, et al. Corticosteroid treatment in the management of idiopathic granulomatous mastitis to avoid unnecessary surgery. Surg Today. 2015; 45: 457-465.
  5. Sakurai K, Fujisaki S, Enomoto K, Amano S, Sugitani M. Evaluation of follow-up strategies for corticosteroid therapy of idiopathic granulomatous mastitis. Surg Today. 2011; 41: 333-337.
  6. Hur SM, Cho DH, Lee SK, Choi MY, Bae SY, Koo MY, et al. Experience of treatment of patients with granulomatous lobular mastitis. J Korean Surg Soc. 2013; 85: 1-6.
  7. Yabanoglu H, Colakoglu T, Belli S, Aytac HO, Bolat FA, Pourbagher A, et al. A Comparative Study of Conservative versus Surgical Treatment Protocols for 77 Patients with Idiopathic Granulomatous Mastitis. Breast J. 2015; 21: 363-369.
  8. Ocal K, Dag A, Turkmenoglu O, Kara T, Seyit H, Konca K. Granulomatous mastitis: clinical, pathological features, and management. Breast J. 2010; 16: 176-182.
  9. Taghizadeh R, Shelley OP, Chew BK, Weiler-Mithoff EM. Idiopathic granulomatous mastitis: surgery, treatment, and reconstruction. Breast J. 2007; 13: 509-513.
  10. Hladik M, Schoeller T, Ensat F, Wechselberger G. Idiopathic granulomatous mastitis: successful treatment by mastectomy and immediate breast reconstruction. J Plast Reconstr Aesthet Surg. 2011; 64: 1604-1607.
  11. Asoglu O, Ozmen V, Karanlik H, Tunaci M, Cabioglu N, Igci A, et al. Feasibility of surgical management in patients with granulomatous mastitis. Breast J. 2005; 11: 108-114.
  12. Kok KY, Telisinghe PU. Granulomatous mastitis: presentation, treatment and outcome in 43 patients. surgeon. 2010; 8: 197-201.
  13. Akbulut S, Yilmaz D, Bakir S. Methotrexate in the management of idiopathic granulomatous mastitis: review of 108 published cases and report of four cases. Breast J. 2011; 17: 661-668.
  14. Akbulut S, Arikanoglu Z, Senol A, Sogutcu N, Basbug M, Yeniaras E, et al. Is methotrexate an acceptable treatment in the management of idiopathic granulomatous mastitis? Arch Gynecol Obstet. 2011; 284: 1189-1195.
  15. Bouton ME, Jayaram L, O'Neill PJ, Hsu CH, Komenaka IK. Management of idiopathic granulomatous mastitis with observation. Am J Surg. 2015; 210: 258-262.
  16. Tuli R, O'Hara BJ, Hines J, Rosenberg AL. Idiopathic granulomatous mastitis masquerading as carcinoma of the breast: a case report and review of the literature. Int Semin Surg Oncol. 2007; 4: 21.
  17. Erhan Y, Veral A, Kara E, Ozdemir N, Kapkac M, Ozdedeli E, et al. A clinicopthologic study of a rare clinical entity mimicking breast carcinoma: idiopathic granulomatous mastitis. Breast. 2000; 9: 52-56.