Background: Granulomatous mastitis is a chronic inflammatory condition of the breast with uncertain cause that may be confused with cancer breast. The optimal managing strategy of such condition is still unknown due to its uncertain cause, low incidence, uncertain diagnosis and high recurrence rate. There are many previous studies which compared between both surgical and medical management strategies, but their results are not accurate due to their limited number. The aim of our study was to compare between both surgical and medical management strategies of idiopathic granulomatous mastitis to determine the most beneficial and effective approach of management. Patients and Methods: We carried out that study on 150 granulomatous mastitis patients. We divided patients into two groups; Group 1 underwent surgical management strategy Group 2 underwent conservative medical management strategy in addition to systemic steroids. We record all included patients outcomes and follow-up data. Results: We have found no statistically significant differences between both included groups of patients regarding etiological and demographic factors. Average recovery period for the 75 surgically managed patients was 1.5 (1–4) months, but it was 7 (2–14) months for the 75 medically managed patients who administered steroids (p = 0.002). There are no recurrences in patients in Group 1 while there are recurrences in group 2 (p = 0.005). Conclusions: Wide local excision with safety negative margin is the recommended strategy for treatment of idiopathic granulomatous mastitis mimic breast cancer. It provides rapid recovery and less recurrence than medical treatment