- J Michael Dixon, MD
J Michael Dixon, MD
- Professor of Surgery and Consultant Surgeon
- Edinburgh University
- Section Editors
- Anees B Chagpar, MD, MSc, MA, MPH, MBA, FACS, FRCS(C)
Anees B Chagpar, MD, MSc, MA, MPH, MBA, FACS, FRCS(C)
- Section Editor — Breast Surgery
- Associate Professor, Department of Surgery
- Yale University School of Medicine
- Daniel J Sexton, MD
Daniel J Sexton, MD
- Editor-in-Chief — Infectious Diseases
- Section Editor — Bacterial Infections
- Professor of Medicine
- Duke University Medical Center
Mastitis refers to inflammation of the breast tissue that may or may not be accompanied by infection. Mastitis does not necessarily occur during lactation, is not always accompanied by microbial infection, and may not resolve with antibiotics. Forms of nonlactational mastitis include periductal mastitis and idiopathic granulomatous mastitis.
Issues related to nonlactational mastitis will be reviewed here; issues related to lactational mastitis are discussed separately. (See "Lactational mastitis".)
Periductal mastitis is an inflammatory condition of the subareolar ducts; the cause is unknown. Periductal mastitis primarily affects young women but can occur in men as well.
The majority of patients with periductal mastitis are smokers. It has been postulated that smoking is associated with damage of the subareolar ducts, with tissue necrosis and subsequent infection [1,2]. The toxic substances in cigarette smoke may damage the ducts directly or there may be a localized hypoxic effect. In a study of 139 patients with the clinical or pathologic diagnosis of periductal mastitis, 89 percent were smokers (as compared with 39 percent of age-matched controls). The breast concentrates substances in cigarette smoke; cotinine, a nicotine derivative, has higher concentrations in subareolar ducts than in plasma [3-5].
Periductal mastitis is also associated with squamous metaplasia, which is likely a consequence of ongoing inflammation. It has been suggested that squamous metaplasia may lead to partial duct obstruction with subsequent dilatation and secondary inflammation and infection [2,6,7]. However, as normal ducts are blocked by keratin, it is the author's view that duct obstruction, duct dilatation, and squamous metaplasia are not precursors of periductal inflammation or relevant etiologic factors.
- Dixon JM. Breast infection. In: ABC of Breast Diseases, Dixon JM (Ed), Blackwell Publishing, Oxford 2006. p.19.
- Dixon JM, Ravisekar O, Chetty U, Anderson TJ. Periductal mastitis and duct ectasia: different conditions with different aetiologies. Br J Surg 1996; 83:820.
- Schäfer P, Fürrer C, Mermillod B. An association of cigarette smoking with recurrent subareolar breast abscess. Int J Epidemiol 1988; 17:810.
- Bundred NJ, Dover MS, Coley S, Morrison JM. Breast abscesses and cigarette smoking. Br J Surg 1992; 79:58.
- Hill P, Wynder EL. Nicotine and cotinine in breast fluid. Cancer Lett 1979; 6:251.
- ZUSKA JJ, CRILE G Jr, AYRES WW. Fistulas of lactifierous ducts. Am J Surg 1951; 81:312.
- Lannin DR. Twenty-two year experience with recurring subareolar abscess andlactiferous duct fistula treated by a single breast surgeon. Am J Surg 2004; 188:407.
- Dixon JM, Bundred NJ. Management of disorders of the ductal system and infections. In: Diseases of the Breast, Harris JR, Lippman ME, Morrow M, Osborne CK (Eds), Lippincott Williams & Wilkins, Philadelphia 2004. p.47.
- Dixon JM. Periductal mastitis and duct ectasia: an update. The Breast 1998; 7:128.
- Dixon JM, Thompson AM. Effective surgical treatment for mammary duct fistula. Br J Surg 1991; 78:1185.
- Gollapalli V, Liao J, Dudakovic A, et al. Risk factors for development and recurrence of primary breast abscesses. J Am Coll Surg 2010; 211:41.
- Bharat A, Gao F, Aft RL, et al. Predictors of primary breast abscesses and recurrence. World J Surg 2009; 33:2582.
- Dixon JM. Periductal mastitis/duct ectasia. World J Surg 1989; 13:715.
- Greydanus DE, Matytsina L, Gains M. Breast disorders in children and adolescents. Prim Care 2006; 33:455.
- Browning J, Bigrigg A, Taylor I. Symptomatic and incidental mammary duct ectasia. J R Soc Med 1986; 79:715.
- Schwartz GF. Benign neoplasms and "inflammations" of the breast. Clin Obstet Gynecol 1982; 25:373.
- Bundred NJ, Dixon JM, Lumsden AB, et al. Are the lesions of duct ectasia sterile? Br J Surg 1985; 72:844.
- Ammari FF, Yaghan RJ, Omari AK. Periductal mastitis. Clinical characteristics and outcome. Saudi Med J 2002; 23:819.
- Rahal RM, Júnior RF, Reis C, et al. Prevalence of bacteria in the nipple discharge of patients with duct ectasia. Int J Clin Pract 2005; 59:1045.
- Dixon J, Lee E, Greenall M. Treatment of periareolar inflammation associated with periductal mastitis using metronidazole and flucloxacillin: A preliminary report. Br J Clin Pract 1988; 42:78.
- Dixon JM. Breast abscess. Br J Hosp Med (Lond) 2007; 68:315.
- Komenaka IK, Pennington RE Jr, Bowling MW, et al. A technique to prevent recurrence of lactiferous duct fistula. J Am Coll Surg 2006; 203:253.
- Almasad JK. Mammary duct fistulae: classification and management. ANZ J Surg 2006; 76:149.
- Meguid M, Kort K, Numann P, Oler A. Subareolar breast abscess: the penultimate stage of the mammary duct-associated inflammatory disease sequence. In: The Breast, 4th edition, Bland K, Copeland III E (Eds), Elsevier, Philadelphia 2009. Vol 1, p.107.
- PATEY DH, THACKRAY AC. Pathology and treatment of mammary-duct fistula. Lancet 1958; 2:871.
- Dixon JM. Breast surgery. In: Infection in surgical practice, Taylor EW (Ed), Oxford Medical Publications, Oxford 1992. p.187.
- Wilson JP, Massoll N, Marshall J, et al. Idiopathic granulomatous mastitis: in search of a therapeutic paradigm. Am Surg 2007; 73:798.
- Going JJ, Anderson TJ, Wilkinson S, Chetty U. Granulomatous lobular mastitis. J Clin Pathol 1987; 40:535.
- Al-Khaffaf B, Knox F, Bundred NJ. Idiopathic granulomatous mastitis: a 25-year experience. J Am Coll Surg 2008; 206:269.
- Maffini F, Baldini F, Bassi F, et al. Systemic therapy as a first choice treatment for idiopathic granulomatous mastitis. J Cutan Pathol 2009; 36:689.
- 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.
- Néel A, Hello M, Cottereau A, et al. Long-term outcome in idiopathic granulomatous mastitis: a western multicentre study. QJM 2013; 106:433.
- Lai EC, Chan WC, Ma TK, et al. The role of conservative treatment in idiopathic granulomatous mastitis. Breast J 2005; 11:454.
- Kessler E, Wolloch Y. Granulomatous mastitis: a lesion clinically simulating carcinoma. Am J Clin Pathol 1972; 58:642.
- Han BK, Choe YH, Park JM, et al. Granulomatous mastitis: mammographic and sonographic appearances. AJR Am J Roentgenol 1999; 173:317.
- Fletcher A, Magrath IM, Riddell RH, Talbot IC. Granulomatous mastitis: a report of seven cases. J Clin Pathol 1982; 35:941.
- Gombos EC, et al. Granulomatous mastitis. J Women's Imaging 2004; 6:136.
- Ozurk M, et al. Granulomatous mastitis: Radiologic findings. Acta Radiologica 1997; 48:150.
- Aldaqal SM. Idiopathic granulomatous mastitis. Clinical presentation, radiological features and treatment. Saudi Med J 2004; 25:1884.
- Memis A, Bilgen I, Ustun EE, et al. Granulomatous mastitis: imaging findings with histopathologic correlation. Clin Radiol 2002; 57:1001.
- Sabaté JM, Clotet M, Gómez A, et al. Radiologic evaluation of uncommon inflammatory and reactive breast disorders. Radiographics 2005; 25:411.
- Yilmaz E, Lebe B, Usal C, Balci P. Mammographic and sonographic findings in the diagnosis of idiopathic granulomatous mastitis. Eur Radiol 2001; 11:2236.
- Bouton ME, Jayaram L, O'Neill PJ, et al. Management of idiopathic granulomatous mastitis with observation. Am J Surg 2015; 210:258.
- Naraynsingh V, Hariharan S, Dan D, et al. Conservative management for idiopathic granulomatous mastitis mimicking carcinoma: case reports and literature review. Breast Dis 2010; 31:57.
- Munot K, Nicholson S, Birkett V. Granulomatous mastitis - A novel method of treatment. Eur J Surg Oncol 2012; 38:461.
- Akbulut S, Arikanoglu Z, Senol A, et al. Is methotrexate an acceptable treatment in the management of idiopathic granulomatous mastitis? Arch Gynecol Obstet 2011; 284:1189.
- Schmajuk G, Genovese MC. First report of idiopathic granulomatous mastitis treated with methotrexate monotherapy. J Rheumatol 2009; 36:1559.
- Sheybani F, Sarvghad M, Naderi HR, Gharib M. Treatment for and clinical characteristics of granulomatous mastitis. Obstet Gynecol 2015; 125:801.