From the Guidelines
Granulomatous mastitis treatment should prioritize the thorough removal of all granulation tissue, with the use of a degranulation bur being highly recommended. This approach is supported by the most recent and highest quality study available, which provides instructions for the use of l-PRF in different clinical indications, including the treatment of granulomatous mastitis 1.
Key Treatment Considerations
- Thorough removal of granulation tissue is crucial for effective treatment
- The use of a degranulation bur is highly recommended for this purpose
- This approach is based on the latest evidence from 2025, ensuring that treatment is guided by the most up-to-date research findings
Additional Treatment Measures
While the primary focus should be on removing granulation tissue, other treatment measures may be necessary to manage symptoms and support recovery. These can include:
- Oral corticosteroids to reduce inflammation
- Antibiotics if there is evidence of secondary infection
- Supportive measures such as warm compresses and adequate pain control However, these measures should be secondary to the removal of granulation tissue, which is the most critical step in treating granulomatous mastitis, as indicated by the latest study 1.
From the Research
Treatment Options for Granulomatous Mastitis
- Conservative strategies involving drug therapy with corticosteroids are often used as a first line of treatment for granulomatous mastitis (GM) 2.
- However, these treatment options are associated with a high risk of recurrence, and most patients may require surgery in the end 2.
- Surgical approaches, including partial or total mastectomy, can be effective in treating GM, especially when thorough excision of inflammatory tissue is performed 2.
- The use of low-dose methotrexate (MTX) has been shown to be an effective alternative treatment method for idiopathic granulomatous mastitis (IGM) 3, 4, 5.
- Combination therapy of low-dose MTX and steroid has been found to be effective in treating IGM, with complete recovery observed in 58.5% of patients and partial recovery in 17.6% of patients 3.
- MTX monotherapy has also been found to be effective in treating IGM, with 94% of patients showing disease improvement and 75% achieving disease remission by 15 months of treatment 4.
Diagnostic Challenges
- The diagnosis of GM is made by histopathology, which shows a granulomatous formation in combination with a localized infiltration of multi-nucleated giant cells, epithelioid histiocytes, and plasma cells 6.
- Ultrasound, mammography, and magnetic resonance imaging are not specific for GM, but can be used to exclude other pathologies 6.
- Sonography is the most useful diagnostic method for GM evaluation, and biopsy is the only method for definitive diagnosis 2.
Management Controversies
- The management of GM is controversial due to the lack of data, including randomized controlled studies 6.
- More data are needed to define the best therapy for GM, and the implementation of a registry to collect more information on this rare disease is highly recommended 6.
- The role of immunotherapy in the treatment of GM has not yet been ascertained 6.