Not many women
get it or have even
heard of it. But
mastitis suddenly occurs, it can
cause panic and fear.
This is because the condition
shows up as a firm lump in the
breast — a symptom that is
similar to breast cancer. However,
unlike cancerous tumours in the
breast, which are usually painless,
granulomatous mastitis lumps
often cause pain.
“Women who seek attention
for breast lumps usually come
with the concern that they may
be cancerous,” said Dr Julie Liana
Hamzah, Associate Consultant,
Department of Breast Surgery,
Singapore General Hospital (SGH).
Besides pain, other symptoms
can include skin inflammation
and redness, and fever. In more
serious cases, there may be
ulceration or even enlarged
The condition is rare.
According to Dr Julie, her
department sees a handful of
women with granulomatous
mastitis a year. It is unclear what
causes granulomatous mastitis,
although some conditions such as tuberculosis and sarcoidosis, an
inflammatory disease, can lead
to it. Most cases, however, are
idiopathic, meaning no cause can
be found to explain its occurrence,
said Dr Julie.
mastitis tends to show up in
women of childbearing age
between their late 20s and
40s, especially those who have
had children. Nevertheless, the
condition has also been known to
occur in women in this age group
who have not given birth before,
Dr Julie added.
Diagnosis is made by exclusion of
other diseases. “Normally, we will
perform a physical examination
of the woman in the clinic and
send her for breast imaging,” said
Dr Julie. If the scan points to an
infection, oral antibiotics will be
prescribed as the first course
A follow-up ultrasound will
be ordered three months later.
At this point, if this condition
persists, doctors may recommend
a core needle biopsy to sample
and examine tissue from the lesion
to rule out cancer or some other disease. A biopsy is usually not
done at the start.
In cases where the lump is
accompanied by an abscess, the
pus is surgically drained. At the
same time, a tissue sample will be
taken for diagnosis. Non-steroidal
anti-inflammatory drugs will be
prescribed for pain management.
If the pain is not well-controlled,
steroids may be prescribed.
Left untreated, idiopathic
resolves itself in nine to 12
months. However, treatment is
recommended to speed up the
recovery process, and reduce pain
Even after the condition
resolves itself, it can recur. So
the patient may find herself with
another lump or infection in the
breast sometime down the road.
“Having said that, there isn’t
an increased risk of breast cancer
or any other disease for these
women. Idiopathic granulomatous
mastitis isn’t a precursor to
cancer, but it may be a protracted
course and almost always presents
with inflammatory or infective
changes. So we tend to want to
control the pain and treat the
infection,” said Dr Julie.