The Neoadjuvant-Like effect of Steroids in Idiopathic Granulomatous Mastitis Management

Maher, Amira; Mikhaail, Fadi Hani Wahba; Sadary, Abanoub S. N.; Mahfouz, Remon Mamdouh; Ghaly, Ayman Magdy Botrous

doi:10.21608/asjs.2025.409995.1225

The Neoadjuvant-Like effect of Steroids in Idiopathic Granulomatous Mastitis Management

Document Type : Original Article

Authors

¹ Galala University, Attaka, Suez, Egypt

² Breast Surgery Unit, Ain Shams University Hospital, Cairo, Egypt

10.21608/asjs.2025.409995.1225

Abstract

Introduction: Idiopathic granulomatous mastitis (IGM) management is considered a current dilemma. However
the benign nature of the disease mimics breast carcinoma both clinically and radiologically and has a great
rate of relapse and recurrence. Steroids are nowadays implemented in the management of IGM. In our study,
we standardized the corticosteroids as a presurgical management in management of idiopathic granulomatous
mastitis due its neoadjuvant-like effect in decreasing the size of the lesion, to control the disease progression and
to decrease the recurrence rates.
Aim of work: To verify the effect of steroids in the treatment of idiopathic granulomatous mastitis.
Patients and methods: This is a prospective study which includes patients diagnosed with idiopathic
granulomatous mastitis from Ain-Shams University Hospital’s breast clinic and Egyptian railway medical center
breast surgery unit between 2018 to 2024. Fifty-three patients were included in our study, all patients received
corticosteroid therapy followed by surgical excision for the residual lesion.
Results: Clinical and radiological regression was reported after steroid administration resulting in volume
reduction from 7.49 ± 2.216 to 1.73 ± 1.158 cm3 and complete clinical and radiological regression was observed
in 11 cases.40 patients were proceeded to wide local excision for the residual granulomatous lesions. 7 patients
were presented with ipsilateral recurrence with average disease-free interval ranging from 2 to 6 months after
discontinuation of steroids. All those patients showed complete resolution after steroids therapy and didn’t perform
a wide local excision. Cosmetic outcome was excellent in 49.1%.
Conclusion: Corticosteroid therapy has a neoadjuvant-like effect resulting in significant reduction of the lesion
burden and improving surgical feasibility and cosmetic results.

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