Periductal Mastitis

 
Periductal mastitis is beginning to be considered a unique sub-class of duct ectasia. It usually comes to the attention of breast cancer physicians as a differential diagnosis following the discovery of mass behind the nipple, nipple discharge, or nipple retraction. Periductal mastitis develops when a breast duct beneath the nipple becomes infected or inflamed.

It typically occurs with a younger age group than mammary duct ectasia, but the main difference between periductal mastitis and duct ectasia is that the mass develops ‘around‘ the nipple, rather than ‘behind‘.
 

 

Symptoms of periductal mastitis

 
Some of the symptoms could include:-

•  tender breast that is hot to the touch
• nipple discharge (bloody or non-bloody)
• inverted nipple, or an infection of the ducts around the nipple.

However, periductal mastitis is completely benign, but certain aspects of its clinical and mammographic appearance can resemble breast carcinoma. As a result, women who present with symptoms often have a thorough ‘work-up‘ just to be sure.

Treatment

 
Antibiotics are usually given to treat any infection. But left untreated, this condition can develop an abscess (a build up of pus), and sometimes this requires the physician to withdraw the pus manually using a fine needle.

If there is a residual mass, surgery may be required, both to confirm that it is not breast cancer, and to help prevent recurrence and infection. There is some suggestion that smoking might be a factor in developing periductal mastitis, or at least in slowing down the healing process.

Periductal mastitis is not related to breast cancer

 
Periductal mastitis by itself is completely unrelated to breast cancer. In terms of breast cancer screening, it should be noted that while any nipple discharge is alarming to women, the risk of breast cancer when nipple discharge is the only symptom is rather low. The presense of a lump in addition to discharge is of greater concern.

Here’s a few Questions and Answers.

• • What does periductal mastitis look like? Perry’s duck “Al” has sore breasts. (NOT helpful, not funny, grow up Doc…) It looks like an inflamed skin red area extending outward from the edge of the areola.
  • What causes periductal mastitis? Suppose somehow, some negative pressure, vaccuum effect, sucked something from nipple surface, back into the ducts. Think of things that happen to nipples, whoever applies creams, or pinches or sucks or massages breasts, and wonder if anything like that has happened in the past few weeks.
  • Could it be mastitis vs inflammatory breast cancer vs duct ectasia vs cellulitis vs abscess? Anything is possible, you can’t usually absolutely sure at one moment in time. So you and the doctor make a best guess, treat it, or just watch it, and wait for time to pass and see what happens.

   

  References

  • Guray M, Sahin AA; Benign breast diseases: classification, diagnosis, and management. Oncologist. (May 2006);11(5):435-49.
  • Dixon JM, Ravisekar O, Chetty U, et al; Periductal mastitis and duct ectasia: different conditions with different aetiologies. Br J Surg. Jun 1996) 83(6):820-2.
  • Ammari FF, Yaghan RJ, Omari AK; Periductal mastitis. Clinical characteristics and outcome. Saudi Med J.(July 2002) (7):819-22.
  • Bundred, NJ., Dover, MS., Aluwihare, N., Faragher, EB., Morrison, JM.; Smoking and periductal mastitis. BMJ. (Sept.1993) 307(6907): 772–773.
  • Miller, SD., McCollough, ML., DeNapoli, T. Periductal mastitis. Masquerading as carcinoma. Dermatologic surgery (Mar. 1998)Volume: 24.

   

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