NON-LACTATIONAL MASTITIS: SURGICAL MANAGEMENT AND MORPHOLOGICALLY GUIDED DECISION-MAKING ALGORITHM

This article systematizes current evidence on surgical treatment of non-lactational mastitis (NLM) and substantiates a differentiated operative decision-making algorithm based on ultrasound parameters of the abscess cavity and the morphological maturity of the pyogenic membrane. US-guided aspiration is shown to achieve primary success in 78–85% of cases for abscesses ≤3 cm. It is demonstrated that excision of a mature pyogenic membrane (>4 mm) constitutes a mandatory, non-optional operative component. Surgery combined with steroids is shown to reduce GLM recurrence to 4.0% versus 20.9% with steroid monotherapy, while total ductectomy for periductal mastitis reduces recurrence to 4–8% versus 28–42% with standard drainage. Integration of ultrasound parameters and pyogenic membrane morphological maturity into a unified algorithm is substantiated as an evidence-based approach to improving surgical outcomes in NLM.

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