Mastitis

An increasing number of women in their late 30s and early 40s are presenting to me with mastitis. Very often, these ladies have received treatment with no results, or have undergone abscess drainage following mastitis, with recurrent symptoms.

One needs to know what mastitis really means.

Mastitis refers to any inflammation in the breast.

It is generally unilateral and may or may not be associated with the typical signs accompanying an inflammation, such as redness, fever or malaise.

Pain and swelling are the only findings. Sometimes, a patient may have these symptoms occurring insidiously over quite some time, with some relief after taking medicines.

Mastitis may be infective (less common) or non infective (more common).

Infective mastitis requires antibiotics and abscess drainage if there is pus formation.

If the pus culture shows tuberculosis, then anti- tuberculosis therapy has to be started.

Newer tests, like the Gene- expert test for tuberculosis is helping us in improving our diagnostic capabilities.

In non infective mastitis, a biopsy may be required along with the other microbiological tests to rule out infective etiology.

Idiopathic granulomatous mastitis (IGM)

This difficult term is used to denote an even more difficult problem to treat.

IGM is a diagnosis of exclusion, once we have ruled out all other causative factors.

The diagnosis is solely based on the pathology findings which is similar to that seen in tuberculosis, minus the hallmark findings of tuberculosis ( caseation necrosis and acid fast bacilli).

The treatment of IGM is quite different as well. To simply put it, IGM is a condition where there is chronic inflammation in the absence of an infective agent, similar to some autoimmune diseases.

Treatment of IGM consists of steroid administration, which may be prolonged.

In some patients, surgery may be required, especially if there is abscess formation.

The treatment is often long drawn and requires a lot of patience and compliance. Inadequate treatment can often lead to recurrence, which may be even more difficult to treat.