The therapeutic dilemma of idiopathic granulomatous mastitis

: Idiopathic granulomatous mastitis (IGM) is a rare, benign, chronic breast condition thatcan cause repeated abscesses or mass formation in bilateral breasts. The condition can severely impactthe quality of life of affected women. This study aims to evaluate effective treatment modalities, as wellas understand the demographics and clinical presentation of patients with IGM.Methods: An 11-year retrospective review was performed of patients diagnosed with IGM from 1 January2008 to 31 December 2018 at a tertiary breast unit.Results: A total of 77 patients were included in the study. The median age at presentation was 36 yearsold. IGM presented most commonly as a breast lump (98.1%). The median number of flares was2 (1–12). Of the 77 patients, 68.8% (53) were treated with antibiotics, 50.6% (39) with steroids, and44.2% (34) underwent surgery, in the course of their IGM treatment. Forty-five (59.2%) of the 76 patientswith IGM required a multimodal treatment approach to achieve remission. There was no significantdifference in the number of flares no matter the initial treatment (P=0.411), or subsequent treatmentmodality (P=0.343). Smokers had 10 times greater odds of having a “high flare” of IGM compared tothose who did not smoke (P=0.031, odds ratio 10.444, 95% confidence interval 1.092–99.859).Conclusion: IGM is a clinical diagnosis. It is a rare, relapsing breast inflammatory condition thataffects young females with no superior treatment modality. Smoking is associated with higher numberof flares of IGM and should be discouraged in IGM patientsKeywords: Breast inflammation, chronic mastitis, idiopathic granulomatous mastitis, recurrent breast abscess