Santa Barbara Cottage Hospital, 400 W. Pueblo Street, Santa Barbara, CA, 93105, USA.
Ridley Tree Cancer Center at Sansum Clinic, 540 West Pueblo Street, Santa Barbara, CA, 93105, USA.
Int Breastfeed J. 2021 Mar 4;16(1):23. doi: 10.1186/s13006-021-00370-8.
Idiopathic Granulomatous Mastitis (IGM) is a benign chronic inflammatory breast condition that mimics two common breast disorders: breast carcinoma and breast abscess. It can form breast masses, fistulae, and fluid collections, resulting in breast disfigurement with retraction and nipple areolar complex (NAC) inversion. IGM most often presents in women of childbearing age within a few years of pregnancy, and can significantly impact lactation. Despite the prevalence of this disease, no current literature describes an approach to managing IGM during breastfeeding.
A 28-year-old G3P2 patient of Native American origin presented to her obstetrician at 7 months pregnant with worsening left breast swelling and redness. She underwent a mammogram, ultrasound and core needle biopsy that confirmed the diagnosis of Idiopathic Granulomatous Mastitis. During the postpartum period, she underwent intralesional triamcinolone injections of her left breast. Due to the contraindication of breastfeeding after local steroid injection, the patient stopped breastfeeding from the affected breast and continued breastfeeding unilaterally.
Idiopathic Granulomatous Mastitis is a challenging chronic inflammatory breast disease that affects women primarily in the reproductive years, with a higher incidence in patients of Hispanic, Native American, Middle Eastern, and African descent. Treatment of IGM during pregnancy and lactation has thus far not been addressed. We review the literature on the treatment of IGM in the non-lactating population, and propose considerations for treating breastfeeding women affected by this disease. Traditional treatment has included systemic immunosuppression and surgery, but newer literature demonstrates that intralesional injection of steroid can provide significant symptomatic relief to patients. A diagnosis of IGM does not preclude breastfeeding, though patients may experience challenges with milk production and latch on the affected breast. Individualized care should be provided, with considerations given to the following: side effects of systemic steroids, the need to wean a breast being treated with intralesional steroids, and augmentation of milk production on the unaffected breast to promote continued breastfeeding.
特发性肉芽肿性乳腺炎（IGM）是一种良性的慢性炎症性乳腺疾病，类似于两种常见的乳腺疾病：乳腺癌和乳腺脓肿。它可形成乳房肿块、瘘管和积液，导致乳房变形、回缩和乳头乳晕复合体（NAC）反转。IGM 最常发生于妊娠后数年的育龄妇女，且可显著影响哺乳。尽管这种疾病很常见，但目前尚无文献描述在哺乳期管理 IGM 的方法。
一位 28 岁的 G3P2 患者，为美洲原住民，在怀孕 7 个月时因左乳房肿胀和发红加重就诊于她的产科医生。她接受了乳房 X 线摄影、超声和空心针活检，这些检查均证实了特发性肉芽肿性乳腺炎的诊断。在产后期间，她接受了左乳房内固醇注射治疗。由于局部类固醇注射后母乳喂养禁忌，患者停止了患侧乳房的母乳喂养，改为单侧母乳喂养。
特发性肉芽肿性乳腺炎是一种具有挑战性的慢性炎症性乳腺疾病，主要影响生育期妇女，且发病率在西班牙裔、美洲原住民、中东和非洲裔患者中更高。在妊娠和哺乳期治疗 IGM 尚未得到解决。我们回顾了非哺乳期 IGM 治疗的文献，并提出了治疗患有这种疾病的哺乳期妇女的注意事项。传统治疗包括全身免疫抑制和手术，但新的文献表明，类固醇内固醇注射可显著缓解患者的症状。IGM 的诊断并不排除母乳喂养，但患者可能会在患侧乳房遇到产奶和衔乳方面的挑战。应提供个体化护理，并考虑以下因素：全身类固醇的副作用、需要给接受类固醇内固醇治疗的乳房断奶、以及增加未受影响乳房的产奶量以促进继续母乳喂养。
