Please suggest treatment for granulomatous mastitis.

Hi,

Welcome to icliniq.com.

I concur with your surgeon's advice in principle. Though to be accurate and specific, I would like to go over your biopsy report, medical records, and surgeon's notes. So kindly follow-up with more information or continue treatment as advised by your doctor.

Hi,

Welcome back to icliniq.com.

Thanks for following up with well-taken pictures of your medical records (attachment removed to protect patient identity). There are a couple of things I can tell you.

1. It is not cancer, and it is unlikely to increase your risk of breast cancer in the future. It is a condition called periductal mastitis, that is, the inflammation of milk ducts under the areola region. In your case, it was one single duct.
2. It presented as a small solid tumor on examination of your breast, and your surgeon thought it to be a fibroadenoma and removed it. I would have gone for aspiration of the cystic swelling and culture of contents to look for any infection. However, confusion arose because of the recent ultrasound, which suggested solid lesions because of partial healing over the last six months.
3. Your doctor mistook it to be fibroadenomas and removed one of them. It might be easier for me to see through this and comment in hindsight, than your doctor who was confronted with two contradictory reports.
4. This type of inflammation of the milk duct may or may not have associated infection of the duct. Needle aspiration of the cystic swelling would have given this opportunity to test for and treat an infection without surgery. But since that lesion has been taken out, hope the area is clear of infection and this disease does not recur.
5. If any infection is present, then appropriate antibiotics taken three times a day for two to three weeks can help. The success rate of this trial is around 50 %. The drug prescribed by your doctor is Claribid (Clarithromycin 500 mg), one tablet daily, once a day after meals for three weeks. This, in my opinion, is the inappropriate dose and frequency of this particular antibiotic medication.
6. Firstly, it is not a first-line recommended medication for this problem, and secondly, it should be taken three times a day. Do confirm with him as to why it has been given in this particular dose. Lastly, as it has already been two weeks of antibiotics, I think now it is time just to stop everything by a week or so.
7. Periductal mastitis can actually be a difficult condition to treat in some cases where there is repeated infection of other milk ducts. Such situations will need surgery to take out all the milk ducts from underneath the nipple.
8. So, talk to your doctor regarding the medication. I hope you shall do fine. I hope this helps you understand what happened and what to do now. Feel free to get back with a picture of the surgery site and any new records.