Targeted Duct Excision Reduces Recurrence and Shortens Treatment Duration in Periductal Mastitis: A Retrospective Cohort Study

Objective: Periductal mastitis (PDM) is characterized by prolonged treatment and high recurrence, yet no large-scale study has identified its recurrence risk factors. Methods: A total of 150 treatment-naïve patients diagnosed with PDM at the Third People’s Hospital of Chengdu from January 2019 to March 2025 were retrospectively included. Univariate and multivariate Cox regression analyses were used to identify factors associated with recurrence; Kaplan–Meier and log-rank tests assessed recurrence-free survival. Baseline patient characteristics, along with treatment duration, time to recurrence, and cosmetic outcomes, were systematically recorded. Results: Targeted duct excision was the only independent protective factor against recurrence (adjusted HR = 0.09, 95% CI: 0.04– 0.20; p < 0.001). The recurrence rate was 9.0% (7/78) in the excision group versus 70.8% (51/72) in the non-excision group. Median initial treatment duration was shorter (52 [29– 73] vs 110.5 [81– 145] days; p < 0.001), and among relapsed patients, time from initial treatment end to recurrence was longer (136 [108– 159] vs 75 [54– 96] days; p < 0.001). Among patients who underwent targeted duct excision, cosmetic outcomes were favorable, characterized by inconspicuous periareolar scars, high patient satisfaction (88.5%), and successful correction of inverted nipples in eligible cases. Conclusion: In patients with PDM, targeted duct excision significantly reduces recurrence risk, shortens treatment duration, and preserves breast appearance, suggesting that this surgical approach should be considered as the primary treatment option for PDM.