Association of the Japanese herbal kampo medicine kakkonto with antibiotic use and surgical drainage for noninfectious mastitis: A nationwide database study.

AIM: Kakkonto, a Japanese herbal kampo medicine, is empirically prescribed to improve milk stasis and ameliorate breast inflammation in patients with noninfectious mastitis. We investigated whether early use of kakkonto is associated with a reduction in antibiotic use and surgical drainage in patients with noninfectious mastitis. METHODS: We identified 34 074 patients with an initial diagnosis of noninfectious mastitis within 1 year of childbirth between April 2012 and December 2022 using the nationwide administrative JMDC Claims Database. Patients were divided into the kakkonto (n = 9593) and control (n = 9648) groups if they received and did not receive kakkonto on the day of the initial diagnosis of noninfectious mastitis, respectively. Antibiotic administration and surgical drainage within 30 days after the initial diagnosis of noninfectious mastitis in the two groups were compared using propensity score-stabilized inverse probability of treatment weighting analysis. RESULTS: The frequency of antibiotic administration within 30 days after the initial diagnosis of noninfectious mastitis was significantly lower in the kakkonto group than in the control group (10% vs. 12%; odds ratio, 0.88 [95% confidence interval, 0.80-0.96]). The frequency of antibiotic administration during 1-3 and 4-7 days after the initial diagnosis were also significantly lower in the kakkonto group than in the control group. The frequency of surgical drainage did not differ significantly between the two groups. CONCLUSIONS: Kakkonto was associated with reduced administration of antibiotics for noninfectious mastitis, making it a potential treatment option for relieving breast inflammation and promoting antimicrobial stewardship.

LC/MS-based untargeted lipidomics reveals lipid signatures of nonpuerperal mastitis.

BACKGROUND: Nonpuerperal mastitis (NPM) is a disease that presents with redness, swelling, heat, and pain during nonlactation and can often be confused with breast cancer. The etiology of NPM remains elusive; however, emerging clinical evidence suggests a potential involvement of lipid metabolism. METHOD: Liquid chromatography‒mass spectrometry (LC/MS)-based untargeted lipidomics analysis combined with multivariate statistics was performed to investigate the NPM lipid change in breast tissue. Twenty patients with NPM and 10 controls were enrolled in this study. RESULTS: The results revealed significant differences in lipidomics profiles, and a total of 16 subclasses with 14,012 different lipids were identified in positive and negative ion modes. Among these lipids, triglycerides (TGs), phosphatidylethanolamines (PEs) and cardiolipins (CLs) were the top three lipid components between the NPM and control groups. Subsequently, a total of 35 lipids were subjected to screening as potential biomarkers, and the chosen lipid biomarkers exhibited enhanced discriminatory capability between the two groups. Furthermore, pathway analysis elucidated that the aforementioned alterations in lipids were primarily associated with the arachidonic acid metabolic pathway. The correlation between distinct lipid populations and clinical phenotypes was assessed through weighted gene coexpression network analysis (WGCNA). CONCLUSIONS: This study demonstrates that untargeted lipidomics assays conducted on breast tissue samples from patients with NPM exhibit noteworthy alterations in lipidomes. The findings of this study highlight the substantial involvement of arachidonic acid metabolism in lipid metabolism within the context of NPM. Consequently, this study offers valuable insights that can contribute to a more comprehensive comprehension of NPM in subsequent investigations. TRIAL REGISTRATION: Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine (Number: 2019-702-57; Date: July 2019).

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 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. 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 (n:11), periareolar combined radial incision (n:7), and round block incision (n:2)]. RESULTS: The 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. CONCLUSIONS: In 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.

Application of arthroscopic system in the treatment of lactational breast abscess.

PURPOSE: Optimal treatment of breast abscesses has been controversial. Herein, we report an innovative method for the operative treatment of lactational mammary abscesses. METHODS: Nineteen lactating patients diagnosed with breast abscesses were enrolled in the study, and abscess debridement and drainage were performed using an arthroscopic system. The clinical characteristics of the patients were recorded to evaluate the feasibility, efficacy, and cosmetic results of arthroscopic surgery for breast abscesses. RESULTS: All 19 patients were cured and did not relapse within the 6-month-follow-up period. One patient stopped breastfeeding due to breast leakage. All patients were satisfied with the postoperative appearance of the breast. CONCLUSION: Arthroscopic debridement and drainage are effective treatment methods for lactational breast abscesses, with a high cure rate, few complications, and satisfactory cosmetic outcomes.

[Case of Spindle Cell Carcinoma of the Breast Diagnosed as Mastitis].

The patient was a 51-year-old woman, who came to our hospital because of pain in her left breast and a tumor. US examination demonstrated a low echoic area with irregular margin and many high echoic spots within the left breast. We diagnosed mastitis. Therefore, we administered an antibiotic. One week later, her pain was improved. However, the low echoic area did not improve. Thus, we performed an aspiration cytology. Pus was aspirated. Cytology revealed a carcinoma. Enhanced CT demonstrated an irregular mass with ring enhancement in the left breast. A mastectomy with sentinel lymph- node biopsy and reconstruction with the latissimus dorsi muscle flap was performed. Post-operative course was uneventful. The pathological finding was of spindle cell carcinoma. After operation, she underwent chemotherapy(AC). Ten years later, she is alive with no recurrence.

Surgical drainage of lactational breast abscess with ultrasound-guided Encor vacuum-assisted breast biopsy system.

Lactational breast abscess is a serious complication of mastitis and commonly diagnosed in breast-feeding women. The traditional drainage of breast abscess was often performed with incisive technique which may result in prolonged healing time, regular dressings, dressing pain, interfering with breastfeeding and unsatisfactory cosmetic outcome. As minimal invasive alternatives to incisive drainage, needle aspiration or percutaneous catheter placement cannot completely replace incisive drainage for the inability to treat large, multiloculated or chronic abscess. Vacuum-assisted breast biopsy system (VABB) has been successfully applied in the treatment of benign breast diseases with satisfactory cosmetic outcomes. Among VABB devices, EnCor system has some distinctive features that make it an appropriate candidate for the treatment of lactational breast abscesses. In this study, for the first time, we investigated the feasibility, efficacy, and cosmetic results of surgical drainage of lactational breast abscess with US-guided Encor VABB system. Our data suggests this procedure could serve as a promising alternative for women with lactational breast abscess who require incisive intervention with high cure rate, relatively short healing time, low recurrence rate, few complications, satisfactory cosmetics outcome and without interfering with breastfeeding.

Diabetic Mastopathy: A Systematic Review of Surgical Management of a Rare Breast Disease.

Diabetic mastopathy is a benign condition of the breast that typically manifests in patients with diabetes mellitus. Lymphocytic mastopathy is the term used to describe this condition in patients without diabetes mellitus. Most patients undergo excisional biopsy, but the use of mastectomy, even in cases of diffuse, bilateral disease, is rarely reported. We present a 32-year-old female patient with type 1 diabetes and bilateral diabetic mastopathy. Because of pain, and concern for limitations in future cancer detection, she underwent bilateral nipple-sparing mastectomies with immediate direct-to-implant reconstruction. A systematic literature review was performed to examine the treatment options for this disease, particularly from a plastic surgery perspective. Sixty articles were reviewed which contained information regarding 313 patients. Of these patients, only 4 underwent mastectomy. This case is the first report of bilateral nipple sparing mastectomy and immediate implant reconstruction for a patient with bilateral, symptomatic diabetic mastopathy.

The Clinical Application of Mastectomy With Single Incision Followed by Immediate Laparoscopic-Assisted Breast Reconstruction With Latissimus Dorsi Muscle Flap.

OBJECTIVE: To explore the clinical application of mastectomy with single incision followed by immediate laparoscopic-assisted breast reconstruction with latissimus dorsi muscle flap. METHODS: Fifteen women with primary early breast cancer, 3 women with breast ductal carcinoma in situ, and 7 women with severe plasma cell mastitis were treated with partial mastectomy or total mastectomy, sentinel lymph node biopsy, or axillary lymph node dissection through a breast lateral transverse incision. Subsequent breast reconstruction with latissimus dorsi muscle flap was assisted by laparoscopy. The patient's position, time used in dissecting latissimus dorsi muscle flap, size of latissimus dorsi muscle flap, postoperative complications, and the cosmetic results after reconstruction were assessed. RESULTS: All the operations were well done through the breast lateral transverse incision and assistance of laparoscopy. The patient's position was changed only once during the operation. It took 1.5 to 2 hours to dissect latissimus dorsi muscle flap. The sizes of the latissimus dorsi muscle flap were 5 to 8 × 12 to 16 cm. There were no serious postoperative complications noted. The patients were satisfied with the appearance of the breasts and the small surgical scar. CONCLUSION: The surgical approach introduced is minimally invasive with concealed scar and outstanding cosmetic results. It is worth promoting in clinical application.

Immunoglobulin G4 -related Sclerosing Mastitis: AIRP Best Cases in Radiologic-Pathologic Correlation.

Editor's Note.-RadioGraphics continues to publish radiologic-pathologic case material selected from the American Institute for Radiologic Pathology (AIRP) "best case" presentations. The AIRP conducts a 4-week Radiologic Pathology Correlation Course, which is offered five times per year. On the penultimate day of the course, the best case presentation is held at the American Film Institute Silver Theater and Cultural Center in Silver Spring, Md. The AIRP faculty identifies the best cases, from each organ system, brought by the resident attendees. One or more of the best cases from each of the five courses are then solicited for publication in RadioGraphics. These cases emphasize the importance of radiologic-pathologic correlation in the imaging evaluation and diagnosis of diseases encountered at the institute and its predecessor, the Armed Forces Institute of Pathology (AFIP).

Clinical efficacy of fiberoptic ductoscopy in combination with ultrasound-guided minimally invasive surgery in treatment of plasma cell mastitis.

OBJECTIVES: To analyze clinical efficacy between fiberoptic ductoscopy plus ultrasound-guided minimally invasive irrigation and lesion resection in treating plasma cell mastitis (PCM), aiming to provide clinical evidence for treating PCM. MATERIALS AND METHODS: 119 patients undergoing fiberoptic ductoscopy plus ultrasound-guided minimally invasive surgery in Ningxia People's Hospital were allocated into the breast duct irrigation group, and 95 counterparts receiving lesion resection in the Affiliated Hospital of Ningxia Medical University into the control group. Clinico-pathological characteristics and therapeutic effect were compared between two groups. RESULTS: The cure rate in the breast duct irrigation group was 98.31% (117/119), significantly higher than 90.53% in the control group (p < 0.05). In the breast duct irrigation group, overall treatment time was 20.13 days, significantly longer than 15.15 days in the control group (p < 0.05). During postoperative follow-up, no recurrence was observed, significantly lower compared with 48.8% (42/86) in the control group. The degree of satisfaction in the breast duct irrigation group was 95.79% (114/119), significantly higher compared with 74.74% (71/95) in the control group. CONCLUSIONS: Fiberoptic ductoscopy plus with ultrasound-guided minimally invasive drainage is a novel and effective treatment of PCM with high cure rate, low recurrence rate, slight pain, and effectively maintains breast integrity.

[Peculiarities of the course, diagnosis and surgical treatment of non-lactating mastitis]. / Osobennosti techeniya, diagnostiki i khirurgicheskogo lecheniya nelaktatsionnogo mastita.

AIM: To improve treatment of patients with non-lactating mastitis through the study of the course, diagnosis and surgical treatment. MATERIAL AND METHODS: The study included 336 women aged 18-72 years with non-lactating mastitis who were hospitalized into the clinic for the period 1999-2016. RESULTS: Main clinical variants of the disease, spectrum of pathogens and its relationship with clinical forms of mastitis were determined. Also early and long-term outcomes were evaluated followed by formulation of therapeutic and diagnostic concept of surgical care for non-lactating mastitis. Thus, good results were obtained in most cases (95.8% in early period and 92.6% in long-term period). CONCLUSION: Only differentiated approach to diagnostic and curative tactics will allow to achieve good cosmetic and functional results in these patients.

Dermo-glandular flap for treatment of recurrent periductal mastitis.

BACKGROUND: Recurrent periductal mastitis (PDM) is usually refractory to medical treatment and normally requires surgical intervention or even mastectomy. This study aimed to evaluate the effectiveness and safety of extended excision with transferring a random breast dermo-glandular flap (BDGF) in the treatment of severe PDM. MATERIALS AND METHODS: Between January 2010 and December 2011, 47 patients with recurrent PDM were consecutively and prospectively hospitalized for elective extended excision. A random BDGF was harvested from the ipsilateral breast tissue overlying the pectoralis major muscle and transferred to resurface the breast tissue defect. The donor site wound was closed using interrupted sutures. Main outcome measures included flap survivability, surgical morbidities, and follow-up cosmetic outcome. RESULTS: All flaps survived uneventfully and all wounds healed by primary intention. PDM recurred in two patients (2/47, 4.3%) and required second-look surgery. The cosmetic outcome was self-evaluated to be excellent in 31.9% (15/47) of patients, good in 36.2% (17/47), acceptable in 21.3% (10/47), and poor in 10.6% (5/47), respectively. The donor site wounds healed uneventfully with minimal scarring. CONCLUSIONS: Extended excision with transferring BDGF is an effective, safe treatment modality for recurrent PDM with a low-risk morbidity and favorable cosmesis.

Breast ductal carcinoma in situ presenting as recurrent non-puerperal mastitis: case report and literature review.

Breast ductal carcinoma in situ (DCIS) is a preinvasive form of breast cancer. It typically presents as microcalcifications which are picked up on screening mammogram. We report an atypical case of breast DCIS presenting with recurrent non-puerperal mastitis with a normal mammogram and perform a literature review.

Therapeutic strategy for granulomatous lobular mastitis: a clinicopathological study of 12 patients.

Granulomatous lobular mastitis (GLM) is a rare inflammatory pseudotumor. No therapeutic modality for this disease has been established because of its rarity. The purpose of this study is to evaluate the treatment strategies of GLM. Twelve women who met the histological criteria for GLM were retrospectively studied. The clinical data and the presentation, histopathology, and management of the disease were analyzed by reviewing the patients' medical records. The diagnosis of GLM was confirmed histologically by core needle biopsy in 9 cases, by vacuum-assisted biopsy in 2 cases, and by excisional biopsy in 1 case. Ten patients received corticosteroid treatment and another two patients were treated with local excision or incision and drainage. The median initial dosage of corticosteroid (Prednisolone) was 30 mg/day (range: 15-60 mg/day), and the dosages were tapered according to improvement. The median duration of corticosteroid treatment was 5 months (range: 1-12 months). The median follow-up period was 22 months (range: 6-104 months), and no patient treated with corticosteroid demonstrated recurrence. However, patients treated with excision or incision and drainage had recurrences. These results suggest that steroid treatment may be the first choice in treatment strategies for GLM.

Surgical management of silicone mastitis: case series and review of the literature.

BACKGROUND: Free silicone injection for breast augmentation, which became widespread in the 1960s and continues illicitly to this day, has well-known adverse effects. In this retrospective chart review of 14 patients treated for silicone mastitis from 1990 to 2002, we present our experience with the surgical management of patients with silicone mastitis. METHODS: All the patients were women, ranging in age from 49 to 76 years old (mean age = 58.8). Patients presented to us a mean of 29.9 years after their free silicone breast injection. Treatment modalities were analyzed, and, specifically, methods of breast reconstruction involving autologous tissue transfers, implants, or a combination were evaluated. RESULTS: The majority of patients (12 of 14) required mastectomies for extensive silicone-infiltrated tissues. The remaining two patients had focal areas of disease and were successfully treated with excision and local breast parenchyma flaps. Autologous reconstruction was performed with a total of 20 flaps, including 12 free transverse rectus abdominis myocutaneous flaps, 4 free superior gluteal artery perforator (SGAP) flaps, and 4 pedicled latissimus dorsi (LD) flaps. Two patients had bilateral implant-based breast reconstruction. CONCLUSION: A variety of reconstructive options are available for patients presenting with silicone mastitis. Once an appropriate breast cancer workup has been performed, the surgical goal is to excise as much of the silicone-infiltrated tissues as possible before reconstruction. To our knowledge, this is the first reported series that incorporates the use of SGAP and LD flaps as a means of autologous tissue reconstruction for silicone-infiltrated breasts. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

[Recurrent subareolar non puerperal abscess of breast with fistules of lactiferous ducts (Zuskas disease)]. / Rekurentný subareolárny non- puerperálny absces prsníka s fistuláciami ductus lactiferi (Zuskas disease).

INTRODUCTION: Zuskas disease (ZD) is an illness also known as the recurrent subareolar non-puerperal abscess of breast with fistulas of lactiferous ducts or as a periductal mastitis. ZD is rare, but painful chronic disease of breast characterized by local inflammation and evacuation of viscous content from abscess around the nipple. We present a rare form of the non-puerperal mastitis in patients with recurrence of this disease and with the description of management and treatment. CONCLUSION: The treatment of ZD is often inadequate and it leads to the recurrence of ZD and retraction of the nipple. Definitive treatment of ZD is surgical excision of the fistulation, removing of whole retroareolar fibroglandular tissue, abscess cavity and ductal tissue inside the nipple, including the obstructed ducts. The ratio of patients cured by this method is high, as well as their satisfaction with the final cosmetic effect of the nipple and breast.

[Efficacy of application of radiofrequency scalpel and ozono-ultrasound method in dynamics of planimetric indices of the wound course process in the patients, suffering an acute purulent lactation mastitis].

The results of planimetric investigation, conducted in 82 patients, suffering an acute purulent lactation mastitis (APLM), were analyzed. Of them 42 patients (the main group) were operated on, using radiofrequency scalpel, for the postoperative wounds processing the low-frequency ultrasound and ozonated isotonic solution of sodium chloride were used. In 40 patients (group of comparison) the conventional methods of treatment of APLM were applied.

[Efficacy of surgical treatment of patients for an acute lactational mastitis using radiofrequency scalpel and ozono-ultrasonic method].

According to microbial investigation data, conducted preoperatively, intraoperatively, in 7 days postoperatively for an acute purulent lactational mastitis, there was noted significant reduction of the wound microbial soiling while application of radiofrequency scalpel and ozono-ultrasonic method in comparison with such while application of conventional methods of treatment.