I've been practicing since 1993 and had never seen this until this past year--- and not one, but two cases that I will eventually write up with Dr. Karen Bodnar, who consulted with me on these. The first mother presented at the end of pregnancy. She had a history of a prior occurrence on one breast that did quite a lot of damage, and now the other had flared up around 7 mos of pregnancy. The second mother came early in the pregnancy, wanting to know if she would be able to breastfeed. She previously successfully breastfed, but her outbreak occurred after those babies. In the first case the breast doctor wanted to do a mastectomy but the mom decided against that and it eventually resolved over several months and an eventual long course of antibiotics (Dr. Bodnar believes that was coincidental and not cured by the abx). The second mother had large chunks of breast tissue removed like a bad breast reduction surgery, with significant scarring. In both cases the milk came in but lactation was very poor and involution set in despite nursing and pumping. It was my conclusion that there was too much ductal disruption for the milk to exit.
Your client is neither pregnant nor lactating, and neither were my two clients during their initial outbreaks. Here is what I learned in a nutshell: granulomatous mastitis is an autoimmune condition affecting the breast. Abscesses form and erupt, but the fluid is not infectious. The situation can become quite severe and uncomfortable, not to mention messy. Antibiotics are sometimes tried, but typically are not highly effective. Removal of affected breast tissue may also be recommended. The approach that seems more reasoned to me is to treat the autoimmune underpinnings with steroids. Recurrences can and do occur. Below are some references I pulled while researching my cases. I hope this helps.
~Lisa Marasco, MA, IBCLC, FILCA
Aghajanzadeh, M., Hassanzadeh, R., Alizadeh Sefat, S., Alavi, A., Hemmati, H., Esmaeili Delshad, M. S., . . . Massahniya, S. (2015). Granulomatous mastitis: Presentations, diagnosis, treatment and outcome in 206 patients from the north of Iran. Breast. doi:10.1016/j.breast.2015.04.003
Atak, T., Sagiroglu, J., Eren, T., Ali Ozemir, I., & Alimoglu, O. (2015). Strategies to treat idiopathic granulomatous mastitis: retrospective analysis of 40 patients. Breast Dis, 35(1), 19-24. doi:10.3233/bd-140373
Baslaim, M. M., Khayat, H. A., & Al-Amoudi, S. A. (2007). Idiopathic granulomatous mastitis: a heterogeneous disease with variable clinical presentation. World J Surg, 31(8), 1677-1681. doi:10.1007/s00268-007-9116-1
Gupta, R. K. (2010). Fine needle aspiration cytology of granulomatous mastitis: a study of 18 cases. Acta Cytol, 54(2), 138-141.
Mizrakli, T., Velidedeoglu, M., Yemisen, M., Mete, B., Kilic, F., Yilmaz, H., . . . Perek, A. (2015). Corticosteroid treatment in the management of idiopathic granulomatous mastitis to avoid unnecessary surgery. Surg Today, 45(4), 457-465. doi:10.1007/s00595-014-0966-5
Yabanoglu, H., Colakoglu, T., Belli, S., Aytac, H. O., Bolat, F. A., Pourbagher, A., . . . Haberal, M. (2015). A Comparative Study of Conservative versus Surgical Treatment Protocols for 77 Patients with Idiopathic Granulomatous Mastitis. Breast J. doi:10.1111/tbj.12415
Yildiz, S., Aralasmak, A., Kadioglu, H., Toprak, H., Yetis, H., Gucin, Z., & Kocakoc, E. (2015). Radiologic findings of idiopathic granulomatous mastitis. Med Ultrason, 17(1), 39-44. doi:10.11152/mu.2013.2066.171.rfm
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