Modified techniques versus Hadfield\u2019s procedure in patients with periductal mastitis

Kubilay Dalci,Mehmet Onur Gul,Ahmet Gokhan Saritas,Atilgan Tolga Akcam,Ahmet Rencuzogullari,Abdullah Ulku,Serdar Gumus,Melek Ergin,Gurhan Sakman

doi:10.1186/s12893-022-01496-0

Abstract

BackgroundPeriductal mastitis (PM) is a rare disease characterized by chronic inflammation of the terminal mammary ducts. Complete removal of terminal lactiferous ducts with Hadfield procedure is a previously defined technique in treatment but carries various complications risks. This study aims to evaluate the effectiveness of modified techniques in the treatment of PM.MethodsTwenty 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 (n:11), periareolar combined radial incision (n:7), and round block incision (n:2)].ResultsThe mean age was 37.5 ± 6.5 years (range: 24–49). Sixty percent of patients had type 3 PM. In Hadfield’s procedure, NAC retraction (n:2), seroma (n:1), and hematoma (n:1) were seen. In the periareolar incision combined radial incision group only one patient had complications (seroma) and none in the round block method. Follow-up was 12 ± 1.5 months and disease relapse occurred in two patients in the Hadfield group. Patients who underwent round block were more satisfied with the appearance of the nipple.ConclusionsIn the treatment of PM, the main principle of surgical treatment is the excision of the affected canal with a clear margin. Apart from the classical Hadfield procedure, the round block method and periareolar combined radial incision techniques can be performed in the treatment of PM.

Highlights

Periductal mastitis (PM) is a benign disease affecting a terminal lactiferous duct responsible for 1–2% of all symptomatic breast conditions [1]
After determining the duct tract affected by palpation in all patients, the criteria we considered in the incision selection were as follows
Eight patients referred to our clinic had at least one abscess drainage before admission, and two of them were misdiagnosed as idiopathic granulomatous mastitis and received oral corticosteroid therapy

Summary

Introduction

Periductal mastitis (PM) is a benign disease affecting a terminal lactiferous duct responsible for 1–2% of all symptomatic breast conditions [1]. Noncyclic mastalgia, nipple discharge, nipple-areola complex (NAC) retraction, subareolar breast mass with or without mastitis, periareolar abscess, or often lactiferous duct’s fistula can be seen [1]. The disease begins with periductal inflammation that develops due to the obstruction of subareolar lactiferous ducts by keratinous plaques. This inflammation causes duct rupture and periareolar fistula development [4, 5]. Complete removal of terminal lactiferous ducts with Hadfield procedure is a previously defined technique in treatment but carries various complications risks. This study aims to evaluate the effectiveness of modified techniques in the treatment of PM

Objectives

Methods

Results

Conclusion