Gigantomastia with bilateral axillary breasts: Acute onset in pregnancy

Gestational gigantomastia: The sentinel event to systemic lupus erythematosus

Gestational gigantomastia or gravid macromastia is a rare condition presenting as incapacitating breast enlargement during pregnancy. It is physically and psychologically debilitating for the patient. Fewer than 100 cases have been published to date. The etiology of the condition is unknown, but various theories have been proposed. Here we report a case of a 27 year old woman in her second pregnancy, with an abnormal increase in the size of breasts. Her breast size increased from 34B to 52D brassiere size. Routine antenatal, hormone, and initial autoimmune investigations were within normal limits. The patient was managed conservatively with breast support and had a spontaneous resolution in the postpartum period. During follow up she was diagnosed with systemic lupus erythematosus, making the association of the two conditions a possibility. Good knowledge about this rare condition is necessary for all doctors, especially obstetricians.

A Systematic Literature Review of the Clinical Presentation, Management, and Outcome of Gestational Gigantomastia in the 21st Century

BACKGROUND

Gestational gigantomastia (GG) is an uncommon pregnancy condition, and the underlying cause of GG has yet to be determined. Medical management and surgery are two treatment options for GG, and breast reduction or mastectomy with delayed reconstruction is the only available surgical option. We have conducted this systematic review to summarize and critically analyze all the GG data in the literature.

METHODS

The preferred reporting items for systematic reviews and meta-analysis (PRISMA) guidelines were adhered to in reporting this article. A systematic search was conducted in February 2022 for published case reports and case series on GG using the PubMed, MEDLINE, and Cochrane databases. The following keywords were used: macromastia, gestational gigantomastia, and gestational.

RESULTS

A total of 639 articles were searched, and only 66 case reports published between 1962 and 2022 were included. The mean patient's age at presentation was 28.79 years old. The majority of the patients were in their first trimester (n = 23, 47%). The main complaint was rapid bilateral breast enlargement (n = 54, 80.59%). Bromocriptine was the most common medical management used (n = 19/35, 54.28%). Bilateral breast reduction was the most common surgery (n = 24/48, 50%). Most patients had uneventful recovery (n = 40/54, 74.07%).

CONCLUSION

Gigantomastia is a difficult condition, in terms of its management. We have found that surgery is the gold-standard among all the cases reported; while Bromocriptine was the most commonly administered medical therapy. This systematic review provides a guideline for plastic surgeons to better facilitate their care of these patients.

LEVEL OF EVIDENCE III

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Management of gestational gigantomastia with breast reconstruction after mastectomy: case report and literature review

Gestational gigantomastia (GGM) is a rare complication of pregnancy. The etiology of GGM is yet to be fully established. Treatment methods for GGM include medical therapy and surgery. If medical treatment is unsuccessful, surgery may be required. Currently available surgical interventions are either breast reduction or mastectomy with delayed reconstruction. We report a case of a 25-year-old woman (G1P1) who presented with massive enlargement of both breasts during puerperium. Because of the limited effect of medical therapy, surgical intervention was considered to be the first choice. Bilateral mastectomies with grafting of the nipple–areola complex and immediate bilateral tissue expander implantation were performed. Reconstruction was fully completed 8 months after the initial procedure by replacing tissue expanders with definitive implants. Despite being a benign condition, GGM can turn into a serious problem. GGM can be successfully reconstructed by mastectomy with delayed reconstruction and grafting of the nipple–areola complex.

Breast reconstruction after mastectomy for gestational gigantomastia

BACKGROUND

Gestational gigantomastia (GGM) is a rare complication of pregnancy. Management usually is initiated with bromocriptine. If this is unsuccessful, surgery may be required. The surgical management may be by breast reduction or by mastectomy and delayed reconstruction.

CASE

A 24-year-old woman (G1P0) presented at 24 weeks gestation with massive hypertrophy of her breasts. A decision to operate was made by a multidisciplinary team. At 30 weeks gestation, bilateral mastectomies were performed, with removal of more than 8 kg per side. Reconstruction was started 10 months after delivery using tissue expanders followed by definitive implants.

CONCLUSION

GGM can be successfully reconstructed. Knowledge of the treatment process and the expected outcomes can help clinicians inform their patients.

LEVEL OF EVIDENCE V

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Gigantomastia in pregnancy with an accessory axillary mass masquerading as inflammatory carcinoma

Giagantomastia is a rare disorder known to occur in pregnancy, causing enlargement of the breasts greater than that of gravid enlargement. The histological features of gigantomastia are glandular hyperplasia and an increase of stromal tissue. Illustrated by one documented case, cytomorphology of gigantomastia was misdiagnosed as a phyllodes tumor. We document the cytomorphology of an axillary mass in a gravid woman of 24 years with gigantomastia. She presented in her first trimester with bilateral mastalgia and swelling, nonresponsive to antibiotics. Imaging excluded mass breast lesions and a pituitary prolactinoma. The breasts progressively enlarged, became warm, tender, and developed skin ulcerations and a peau d'orange appearance. Subsequently she developed a mass in her left axilla. On aspiration of the mass, some of the cytomorphological features were suspicious for a metastasis, which correlated well with her clinical features. Careful evaluation suggested cytomorphology to be compatible with benign accessory breast tissue with possible hormone related changes of pregnancy. Histology of the excised axillary mass confirmed this diagnosis. Thus, awareness of this rare condition and careful evaluation is mandatory to avoid misdiagnosis in a similar clinical context.

"Gestational gigantomastia": a review article and case presentation of a new surgical management option

BACKGROUND

Gestational gigantomastia is a nightmare to pregnant women. The currently available surgical intervention is either reduction mammoplasty or simple mastectomy. Reduction mammoplasty carries high risk of recurrence. Simple mastectomy is a mutilating option for a benign condition.

METHODS

A thorough literature research was performed for all reported gestational gigantomastia cases. In addition, this study presents a case that was diagnosed and treated at the authors' center.

RESULTS

The patients' age mean age was 26.8 years. Surgical intervention is the only currently available curative option. The authors were able to introduce an alternative surgical technique: bilateral subcutaneous mastectomy (BSCM) with latissimus dorsi muscle flaps (LDF) and free nipple areola complex grafting (FNAG).

CONCLUSION

Despite being a benign condition, gestational gigantomastia could turn to be a catastrophe. BSCM with LDF and FNAG represents an excellent alternative breast saving surgical option. It offers the advantage of restoring normal breast shape with no fear of future recurrences.