Presentation and surgical management of hidradenitis suppurativa of the breast during pregnancy: A case report

INTRODUCTION: Hidradenitis suppurativa (HS) is a chronic inflammatory disease of the skin and soft tissues most commonly affecting the axilla and groin. It presents as recurrent inflamed lesions, abscesses, draining sinus tracts, and scars. Treatment focuses on preventing progression of disease and managing symptoms. There are limited guidelines discussing the treatment of HS during pregnancy as well as the surgical treatment of HS of the breast in young women who desire future lactation. PRESENTATION OF CASE: We present a case of a thirty-six-year-old female with HS of the breast during pregnancy. Her condition was recalcitrant to steroid injections, TNF blocker, antibiotics and incision and drainage. She developed numerous active, infected large interconnected lesions in her right breast. The decision was made to perform total excision of the infected area in the right breast. She underwent primary closure of the wound one week after excision and was able to successfully breast feed after this treatment. DISCUSSION: Treatment of HS includes both medical and surgical modalities and varies based on the severity of disease. In this patient, definitive but conservative pre-partum treatment was necessary to avoid milk fistula or chronic abscess formation, as the patient's desire was successful postpartum lactation. CONCLUSION: This report describes the successful surgical management of a pregnant woman with severe HS of the breast. This represents an alternative management method in an extreme case of HS, where aggressive medical management was contraindicated.