Successful treatment of suppurative granulomatous mastitis (GM), using prolonged aggressive ultrasound-guided aspiration

Introduction: Management of this rare inflammatory breast condition remains controversial. With no coherent treatment rationale described in literature, reporting of novel treatment methods is critical. This descriptive case outlines the avoidance of open surgery in the treatment of a complex abscess associated with IGM, with full resolution of symptoms. Methods: The clinical course of a 32-year old female is described, 3 years postpartum, presenting with unilateral painful multi-centric lumps (R4U4). Results: A core biopsy confirmed a diagnosis of GM. Prior to commencement of steroids, emergency admission led to repeated breast assessment, demonstrating a complex multi-loculated abscess cavity in 3 separate quadrants. Each cavity was aspirated and washed out under ultrasound guidance. The process was repeated twice weekly for 5 weeks and then once weekly for 2 weeks then stopped, with complete resolution of abscess cavity. The patient tolerated the procedure well. Corynybacterium was isolated and 4 weeks of tetracycline prescribed during this period. Conclusion: Management for this condition should be moving away from radical surgical interventions of the past, and a trial of steroids has been found to be effective in many cases (Erozgen, 2010). Where this is not feasible in cases involving suppuration, the author suggests aggressive image guided aspiration as an alternative approach to the open surgical drainage that is often associated with subsequent poor healing.