Everything You Need to Know About Granulomatous Mastitis

What is Granulomatous Mastitis?

Granulomatous Mastitis (GM) is a rare, chronic inflammatory breast disease that primarily affects women of childbearing age, especially within a few years after childbirth. It involves the formation of granulomas, which are small clusters of immune cells that form in response to inflammation, infection, or an unknown trigger.

There are two main types:

1. Idiopathic Granulomatous Mastitis (IGM) – no identifiable cause.

2. Secondary Granulomatous Mastitis – caused by infections (such as tuberculosis or fungal infections), autoimmune disorders, or foreign bodies.

Causes & Risk Factors

While the exact cause of idiopathic granulomatous mastitis is unclear, several risk factors and potential triggers have been identified:

• Recent pregnancy and lactation

• Autoimmune response – the body may attack its own breast tissue.

• Hyperprolactinemia – elevated levels of prolactin (breast milk hormone)

• Oral contraceptives

• Local trauma or surgery

• Infections – especially fungal, parasitic, or mycobacterial (e.g., TB)

• Ethnicity – more common in women of Middle Eastern, Hispanic, and Asian descent

Symptoms of Granulomatous Mastitis

Symptoms can closely mimic breast cancer or breast abscesses, making diagnosis tricky. Common signs include:

• A firm, painful lump in the breast

• Redness and swelling in the affected area

• Nipple retraction or discharge

• Skin ulceration or thickening

• Fistula formation (chronic draining tracts)

• Sometimes, fever or general malaise

The condition often affects one breast (unilateral) and is non-cancerous, though the symptoms can be alarming.

Diagnosis

Diagnosing GM requires ruling out other serious conditions like breast cancer and infectious mastitis. The following tools are used:

1. Clinical Examination

2. Imaging Tests:

   • Ultrasound

   • Mammography

   • MRI (in complex cases)

3. Biopsy – the definitive diagnostic tool:

   • A core needle or excisional biopsy reveals non-caseating granulomas in breast tissue.

   • Additional stains may be used to rule out infections like tuberculosis or fungal infections.

4. Microbiological Testing – cultures to identify any bacterial or fungal cause.

5. Blood Tests – to evaluate inflammation or autoimmune markers.

Treatment Options

Treatment for GM depends on the severity and cause:

1. Observation

• In mild, non-progressive cases, spontaneous resolution may occur.

2. Medications

• Corticosteroids: To reduce inflammation (e.g., Prednisone)

• Immunosuppressants: Methotrexate, azathioprine (if steroids are not enough)

• Antibiotics: If secondary infection is present

• Antitubercular Therapy: If TB is detected

3. Surgical Management

• Drainage: For abscesses or fistulas

• Excision: Surgical removal of affected tissue in recurring or resistant cases

• Mastectomy: Extremely rare, used in severe, non-responsive cases

Prognosis and Recurrence

• GM is benign, but it can be painful, recurrent, and emotionally distressing.

• Up to 50% of patients may experience recurrence.

• Proper follow-up and treatment adherence are essential.

• Multidisciplinary care with surgeons, radiologists, and rheumatologists may be required.

Conclusion

Granulomatous Mastitis, though rare and often misunderstood, is a benign but challenging breast condition that requires careful evaluation and a patient-specific approach. Its symptoms can closely mimic breast cancer, making accurate diagnosis through biopsy and imaging essential. While it may recur and require long-term management, early intervention, the right treatment plan, and consistent follow-up can lead to full recovery in most cases. With growing awareness and improved treatment strategies, women diagnosed with Granulomatous Mastitis can be reassured that they are not alone—and that effective solutions are available to help them regain their health and peace of mind. consult with our specialist book appointment now at +91-8448830013