Nonlactational mastitis in adults
- 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 in adults 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.
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