Modified Techniques Versus Hadfield’s Procedure in Patients With Periductal Mastitis

Background: Periductal mastitis (PM) is a rare disease characterized by chronic inflammation of the terminal mammary ducts. Complete removal of the terminal canals with Hadfield’s operation applied in the treatment carries various complication risks. This study is designed to evaluate the effectiveness of modified techniques and compare them with the Hadfield operation.Methods: Twenty women who underwent surgery due to PM between January 2012 and December 2019 were retrospectively analyzed. Types of PM were determined. All patients were operated on with three different incisions (Hadfield’s operation with periareolar incision, periareolar combined with radial incision, and round block incision). Results: The age mean 37.5±6.5 years (range:24-49). Sixty percent of patients had type three PM. For the affected duct excision, a classic Hadfield’s operation with periareolar incision was performed in 11 patients, periareolar incision combined with radial incision was performed in 7 patients. The round block method was performed on two patients. Seroma was observed in only one of the patients who underwent the modified technique. In Hadfield’s procedure, NAC retraction (n:2), seroma (n:1), and hematoma (n:1) were seen. The follow-up period was 12±1.5 months. Recurrence occurred in two patients, and both had Hadfield’s procedures. Conclusions: The main principle of surgical treatment is excision of the affected canal with a clear margin. In PM treatment, The round block method and periareolar incision combined radial incision modifications of the Hadfield procedure reduce complications and recurrence risk.

Treatments for Periductal Mastitis: Systematic Review and Meta-Analysis

Introduction: Periductal mastitis (PDM) is a complex benign breast disease with a prolonged course and a high risk of recurrence after treatment. There are many available treatments for PDM, but none is widely accepted. This study aims to evaluate the various treatment failure rates (TFR) of different invasive treatment measures by looking at recurrence and persistence after treatment. In this way, it sets out to inform better clinical decisions in the treatment of PDM. Methods: We searched PubMed, Embase, and Cochrane Library databases for eligible studies about different treatment regimens provided to PDM patients that had been published before October 1, 2019. We included original studies written in English that reported the recurrence and/or persistence rates of each therapy. Outcomes were presented as pooled TFR and 95% CI for the TFR. Results: We included 27 eligible studies involving 1,066 patients in this study. We summarized 4 groups and 10 subgroups of PDM treatments, according to the published studies. Patients treated minimally invasively (group 1) were subdivided into 3 subgroups and pooled TFR were calculated as follows: incision and drainage (n = 73; TFR = 75.6%; 95% CI 27.3–100%), incision alone (n = 74; TFR = 20.1%; 95% CI 0–59.9%), and breast duct irrigation (n = 123; TFR = 19.4%; 95% CI 0–65.0%). Patients treated with a minor excision (excision of the infected tissue and related duct; group 2) were divided into 4 subgroups and pooled TFR were calculated as follows: wound packing alone (n = 127; TFR = 2.1%; 95% CI 0–5.2%), primary closure alone (n = 66; TFR = 37.1%; 95% CI 9.5–64.8%), primary closure under antibiotic treatment cover (n = 55; TFR = 4.8%; 95% CI 0–11.4%) , and additional nipple part removal (n = 232; TFR = 9.6%; 95% CI 5.8–13.4%). Patients treated with a major excision (excision of the infected tissue and the major duct; group 3) included the following 2 subgroups: patients treated with a circumareolar incision (n = 142; TFR = 7.5%; 95% CI 0.4–14.7%) and patients treated with a radial incision of the breast (n = 78; TFR = 0.6%; 95% CI 0–3.6%). Group 4 contained patients receiving different major plastic surgeries. The pooled TFR of this group (n = 86) was 3.4% (95% CI 0–7.5%). Conclusion: Breast duct irrigation, which is the most minimally invasive of all of the treatment options, seemed to yield good outcomes and may be the first-line treatment for PDM patients. Minor excision methods, except for primary closure alone, might be enough for most PDM patients. Major excision, especially with radial incision, was a highly effective salvage therapy. The major plastic surgery technique was also acceptable as an alternative treatment for patients with large lesions and concerns about breast appearance. Incision and drainage and minor excision with primary closure alone should be avoided for PDM patients. Further research is still needed to better understand the etiology and pathogenesis of PDM and explore more effective treatments for this disease.

Periductal Mastitis: An Inflammatory Disease Related to Bacterial Infection and Consequent Immune Responses?

Periductal mastitis (PDM) is a prolonged inflammatory disease, but the cause of PDM is poorly understood. In the present case control study, 87 PDM and 87 healthy controls were enrolled and the results were evaluated to identify the significant risk factors for PDM. To investigate the roles of bacterial infection and critical cytokines expression, 16S rRNA gene sequencing and bacterial culturing were conducted. We also measured the levels of interferon-γ, interleukin-12A, and interleukin-17A by semiquantitative immunohistochemistry method. In a multivariable logistic regression model, we identified overweight/obesity and late onset of menarche as independent risk factors for PDM. In contrast, age of first birth >27 years had a protective effect. With 16S rRNA gene sequencing, we confirmed bacterial infections were found in all PDM patients, but none of the control patients was positive on the gene expression of 16S rRNA. Our results also demonstrated significant increases of the IFN-γ and IL-12A expression in PDM, but there was no difference in IL-17A expression in these two groups. Taken together, this study suggests that reproductive factors and overweight/obesity are possible predisposing risk factors for PDM. Bacterial infection and the increased expression of some proinflammatory cytokines are associated with the pathogenesis of this disease.