Idiopathic Granulomatosis Mastitis, Time to a Paradigm Change in Treatment

Idiopathic granulomatous mastitis (IGM) is among the chronic diseases of the breast, which is more common in Middle Eastern countries than in Western countries. Since the etiology of the disease is not well known, there is no international consensus on the management of the disease. Antibiotic, Non-Steroidal anti-inflammatory drugs (NSAIDs), corticosteroids, cytotoxic and immunosuppressive medications, surgery, and conservative management are among the therapeutic options. Considering the fact that management of IGM needs long-term treatment and in the long-term, most of the medications may show the side effect, treatment with corticosteroids and other immunomodulators or cytotoxic drugs should be recommended cautiously in a patient whose disease is confined to the breast. According to the evidence and long-term experience, the authors recommend applying conservative management along with the training of the patient on how to drain the collections by physical maneuvers. Obviously, if granulomatous mastitis would be a part of the clinical syndrome of a systemic disease, appropriate treatment should be done according to the underlying disease.