Granulomatous mastitis is a chronic inflammatory disease of the breast of unknown cause, which is characterized by a high tendency to return and complex medical management. It is an immune-mediated disorder in which there are abnormal interactions between innate and adaptive immunity. A key role in the development of the disease is played by an increased level of prolactin, which triggers an inflammatory cascade with the activation of certain types of cells of the immune system and disturbances in the balance of T and B lymphocytes. At the same time, glucocorticoids are used for treatment, but their effectiveness is limited and they do not meet all patient needs. For this reason, science is focusing on immunomodulatory treatment strategies that could better regulate specific immune processes. The review critically evaluates current and new therapeutic approaches, including the potential use of traditional Chinese medicine, and proposes a framework for future targeted treatment strategies.