P25 – Hidradenitis Suppurativa of the breast: a case report of a less common site of manifestation

Author(s):
Whitney Young, Stephanie Lueckel, William Cioffi, Daithi Heffernan, Brown University, Rhode Island Hospital

Background: Hidradenitis suppurtiva (HS) is a chronic disease characterized by inflammation, infection with abscesses, and sinus tract formation and scarring. It most often affects the apocrine gland baring skin of axillary, inguinal and genital regions. Breast HS is a less well described entity and often confined to the infra-mammary fold(IMF). Wide local excision is recommended for axillary or groin HS. However, for Breast HS this may require mastectomy because of the more diffuse nature of breast apocrine glands.

Hypothesis: Recent case reports of breast reduction techniques with or without nipple re-implantation for Breast HS have been described allowing preservation of the breast.

Methods: We describe a case of bilateral sub-mammary and mammary hidradenitis suppurativa compounded by poor socioeconomic status.

Results: A 44 year old woman presented with recurrent breast abscesses. Her medical history was significant for obesity, smoking, and axillary HS requiring excision and grafting. She ascribed her acute worsening of the Breast HS being due to worsening socioeconomic status resulting in no running water leading to inability to bathe. Examination revealed bilateral sinus tracts, abscesses and scarring in the submammary and inframmary folds with tracking onto the breast approximating the areolar complex on the right (Image). Incision and drainage obtained a large amount of purulence, resolving the immediate problem. Wound care and social work assistance with personal hygiene were the mainstay of early therapy. Following infection resolution, surgical planning included bilateral reduction mammoplasty with re-implantation of the nipple areolar complex allowing for breast conservation.

Conclusions: Breast HS is relatively rare though reported. Non-clinical socioeconomic factors may worsen this disease. Mastectomy removes all the apocrine gland tissue and minimizes recurrence. However, surgeons need to be aware of the potential role of breast preservation techniques in Breast HS.