A 34-year-old heavy smoker has had three episodes of periareolar breast abscess. She now has a persistent discharging sinus at the areolar margin that intermittently leaks milk-like material. What is the most likely diagnosis and definitive treatment?

• A Nipple adenoma, treated by local excision
• B Recurrent idiopathic granulomatous mastitis, treated by corticosteroids
• C Chronic tuberculous mastitis, treated by antitubercular chemotherapy
• D Mammary duct fistula, treated by fistulectomy together with excision of the affected duct system ✓

Explanation

Recurrent periductal mastitis and periareolar sepsis in a smoker can rupture into a major duct, creating a mammary duct fistula that opens at the areolar edge and discharges purulent or milky fluid. Cure requires excision of the fistula tract along with the diseased duct, often via a cone excision of the duct system. Steroids and antitubercular therapy do not address the epithelialised tract, which excludes B and C.

Reference: Bailey and Love's Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.