Idiopathic granulomatous mastitis is a rare, benign inflammatory breast disease whose etiology and pathophysiology are not fully understood. The exact cause of this disease is not yet known, but it is thought that the immune system gives an abnormal reaction against the tissues in the breast. It is seen more frequently in young women who have given birth.
Clinically, idiopathic granulomatous mastitis manifests itself with symptoms such as pain, hardness, swelling, a mass in the armpit, redness and fistula-like openings in the breast skin. In rare cases, swellings under the skin of the arms and legs may also be seen.
While the diagnosis of this disease is supported by imaging methods such as breast ultrasound, mammography and contrast-enhanced breast MRI, a biopsy is required for the definitive diagnosis. Other breast diseases and infections should be taken into consideration in the differential diagnosis.
Standard treatment options include immunosuppressive drugs such as corticosteroids, methotrexate and corticosteroid combinations, or surgical interventions. However, the treatment process can be challenging and the disease can recur.
In recent years, alternative treatment methods such as hirudotherapy have attracted interest. Hirudotherapy is a treatment method that uses medical leeches. The saliva of leeches contains more than 100 biological active substances, such as anti-inflammatory, analgesic and blood-thinning agents. Some studies show that hirudotherapy may be effective in the treatment of idiopathic granulomatous mastitis.
HIRUDOTHERAPY entered my clinical practice 9 YEARS AGO for patients with idiopathic granulomatous mastitis. In light of the experience we have gained as a team over the years, we continue successfully by improving our treatment protocol.
Hirudotherapy applied at the moment symptoms appear significantly prevents the increase of inflammation. The choice of the breast area where leeches are placed, the harmony of these areas with each other, and the duration and frequency of the treatment vary depending on the inflammation status of the disease. When clinical regression occurs, residual foci that cannot be palpated on examination are marked under ultrasound guidance and the treatment is continued until they disappear completely.
The entire treatment process of each patient is determined according to the individual situation and under my supervision. Always following the guidance of experts in health matters is one of the most important steps for a healthy life. While trying to get treated in unlicensed places without Ministry of Health approval, you may harm your health.
Symptoms
The disease most often begins in one breast as a firm, usually painful lump. The lump may enlarge over time, and the skin over it can become red, warm and swollen. Complaints may arise close to the nipple, but they can also appear in the outer parts of the breast.
- One or several firm areas that grow within a short time and may be palpable
- Skin retraction, nipple inversion or thickening of the skin
- Abscesses that drain pus, and tracts opening onto the skin
- Tender, reactive lymph nodes in the armpit on the same side
Some patients also have symptoms outside the breast, such as joint pain or red, tender nodules on the legs. The course can fluctuate, with periods of improvement followed by flare-ups.
Diagnosis
Because imaging findings alone are not conclusive, pathological examination of a tissue sample is essential for diagnosis. A core (needle) biopsy is usually performed under ultrasound guidance. The examination shows clusters of inflammatory cells around the breast lobules, known as granulomas.
Excluding conditions that can mimic the same picture is an important part of the diagnosis:
- Specific infections such as tuberculosis and fungal disease (special stains and cultures may be needed)
- Sarcoidosis and some systemic diseases involving inflammation of blood vessels
- Breast abscess and periductal mastitis
- Inflammatory breast cancer and other malignant tumours
Where needed, additional blood tests or the opinion of rheumatology and infectious diseases specialists may be requested.
Treatment
The treatment plan is individualised according to the extent of the disease, the level of pain, the presence of an abscess or drainage, and the patient's preferences. Which of the options outlined above is appropriate is decided by evaluating the examination and the pathology result together.
- In mild cases, close follow-up and pain control may be sufficient.
- In patients receiving drug therapy, side effects and response to treatment are monitored at regular intervals.
- When an abscess forms, needle drainage under ultrasound guidance may be preferred over extensive surgery where possible.
- Surgical excision is considered in selected cases; wound healing and the risk of recurrence are discussed with the patient.
Supportive approaches such as hirudotherapy, which some studies report may be helpful, are handled as described at the beginning of the page, under a physician's supervision as part of this plan. Since the disease can last for months, regular check-ups remain important until full recovery.
For more detail on surgical options and the surgical process, see the Breast surgery page.
Love yourself and be happy at every moment of life… because love is the best healer.
