Intermammary pilonidal sinus: The first case series

INTRODUCTION: Pilonidal sinus (PNS) is an inflammatory condition caused by hair penetration into the epidermis. It occurs usually in sacro-coccygeal area. Intermammary pilonidal sinus is a very rare variant with a few case reports in literature. The aim of this study is to highlight the presentation and management of intermammary pilonidal sinus. METHOD: A retrospective multicenter case series. Including all cases of intermammary PNS admitted to either of 5 major tertiary hospitals in Kurdistan region of Iraq. Inclusion criteria were any case of intermammary PNS diagnosed by histopathological examination. The data were taken from the medical records and direct interview with the patients. RESULTS: The case series included 12 patients, all case were female. The age range was from 13 to 29. All of cases were obese with body mass index (BMI) ranged between 30.1–32.2 kg/m(2). All of them presented with discharge for a long time ranging between four weeks to two years. Nine cases (75) were diagnosed preoperatively as cases of infected sebaceous cysts. Resection and direct closure without flap were done for nine (75%) of them and in other three cases (25%), the PNS were resected and left for secondary healing. Three of the patients (25%) developed recurrence. CONCLUSION: Intermammary PNS occurs in young, obese ladies with large breasts which are kept in tight brassieres. Resection and primary closure is the main method of management.