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

Introduction: Idiopathic granulomatous mastitis (IGM) management is considered a current dilemma. Howeverthe benign nature of the disease mimics breast carcinoma both clinically and radiologically and has a greatrate 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 granulomatousmastitis due its neoadjuvant-like effect in decreasing the size of the lesion, to control the disease progression andto 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 idiopathicgranulomatous mastitis from Ain-Shams University Hospital’s breast clinic and Egyptian railway medical centerbreast surgery unit between 2018 to 2024. Fifty-three patients were included in our study, all patients receivedcorticosteroid therapy followed by surgical excision for the residual lesion.Results: Clinical and radiological regression was reported after steroid administration resulting in volumereduction from 7.49 ± 2.216 to 1.73 ± 1.158 cm3 and complete clinical and radiological regression was observedin 11 cases.40 patients were proceeded to wide local excision for the residual granulomatous lesions. 7 patientswere presented with ipsilateral recurrence with average disease-free interval ranging from 2 to 6 months afterdiscontinuation of steroids. All those patients showed complete resolution after steroids therapy and didn’t performa wide local excision. Cosmetic outcome was excellent in 49.1%.Conclusion: Corticosteroid therapy has a neoadjuvant-like effect resulting in significant reduction of the lesionburden and improving surgical feasibility and cosmetic results.