Non-lactational mastitis

What it is

Non-lactating mastitis is breast inflammation in a woman who is not breastfeeding, and it comes in three forms: central or periareolar, which is periductal mastitis; peripheral; and granulomatous lobular mastitis.

Central periductal mastitis is active inflammation around a non dilated duct, unlike duct ectasia, and the two are confused with one another. The mean age is young, 30 years, and it shows as periareolar inflammation with or without a mass.

Peripheral non-lactating mastitis is less common. Granulomatous lobular mastitis is a disease of young multiparous women and is mostly unilateral.

Causes and risk

The organism is reported differently in the two places it is named: as streptococcus in one and as S. aureus in the other.

Smoking is important in the aetiology of the central periductal form, and it is the risk factor to ask about.

The peripheral form is associated with DM, RA, steroids treatment and trauma, and with granulomatous lobular mastitis; pilonidal abscess has been reported with it. Where the inflammation is peripheral or away from the areola rather than peri-ductal, autoimmune diseases such as SLE or rheumatoid arthritis are what to suspect.

The causes of granulomatous lobular mastitis are idiopathic, TB and sarcoidosis.