Case ReportsPostpartum Gigantomastia: A Case Report and Review of the Literature Mohammed M. Hegazi, MCh, FRCS Mohamed Marouf, MCh Ahmed Wafiq, MCh Dalai Tamimi, FKFUPath Alaa Saharty, and DCH Saad ShawanFacharzt Mohammed M. Hegazi Address reprint requests and correspondence to Dr. Hegazi: Associate Professor, Plastic Surgery Unit, CMMS, King Faisal University, P.O. Box 2114, Dammam 31451, Saudi Arabia. From the Department of Plastic Surgery (Drs. Hegazi, Marouf, Wafiq, Shawan), and Department of Pathology (Dr. Tamimi), King Faisal University, Dammam. Search for more papers by this author , Mohamed Marouf From the Department of Plastic Surgery (Drs. Hegazi, Marouf, Wafiq, Shawan), and Department of Pathology (Dr. Tamimi), King Faisal University, Dammam. Search for more papers by this author , Ahmed Wafiq From the Department of Plastic Surgery (Drs. Hegazi, Marouf, Wafiq, Shawan), and Department of Pathology (Dr. Tamimi), King Faisal University, Dammam. Search for more papers by this author , Dalai Tamimi From the Department of Plastic Surgery (Drs. Hegazi, Marouf, Wafiq, Shawan), and Department of Pathology (Dr. Tamimi), King Faisal University, Dammam. Search for more papers by this author , Alaa Saharty From the Department of Plastic Surgery (Drs. Hegazi, Marouf, Wafiq, Shawan), and Department of Pathology (Dr. Tamimi), King Faisal University, Dammam. Search for more papers by this author , and Saad Shawan From the Department of Plastic Surgery (Drs. Hegazi, Marouf, Wafiq, Shawan), and Department of Pathology (Dr. Tamimi), King Faisal University, Dammam. Search for more papers by this author Published Online:1 Sep 1993https://doi.org/10.5144/0256-4947.1993.458SectionsPDF ToolsAdd to favoritesDownload citationTrack citations ShareShare onFacebookTwitterLinked InRedditEmail AboutIntroductionAlthough often considered rare, gigantomastia acquires increasing importance from its severe physical and psychological drawbacks. It usually presents during puberty or pregnancy. We report an unusual case of a 35-year-old female who presented immediately after her sixth delivery.CASE REPORTA 35-year-old female, Gravida 7, Para 6, presented with markedly enlarged breasts of six years’ duration, associated with local tenderness, discomfort, backache, and an extensive intertrigo in the submammary crease (Figure 1). The condition started immediately after the birth of her sixth child. Her medical history was unremarkable; in particular, she had received no hormonal agents or birth control pills and gave no history of any endocrinopathy.Figure 1. Anterior view of patient with gigantomastia.Download FigurePhysical examination showed pronounced breast hypertrophy. The inferior poles reached the groin, with hyperemia and generalized nodularity.Radiographic studies including mammography and computerized tomogram (CT scan) of the brain with axial cuts at the sella failed to show any mass and there was a normal ventricular system. Assays of serum prolactin, estradiol, estrone, progesterone, human growth hormone, thyrotrophin, and free thyroxin, as well as urinary free Cortisol, were all within normal limits. A decision of bilateral reduction mammoplasty with transplantation of free nipple-areola complex was made. Preoperative markings on the breast were made for a 4 cm in diameter nipple and 5 cm inframammary fold. A superiorly based skin pedicle was de-epithelialized and folded under the nipple site. Also, a triangle of tissue in the middle of the inframammary fold was de-epithelialized and secured to the chest wall superiorly. A total of 7,325 grams was excised from the right breast and 7,560 grams from the left breast (Figure 2). The operative blood loss was approximately 600 cc and two units of packed red blood cells were given intraoperatively. A triple dose of perioperative prophylactic antibiotic was given. She was discharged home on the seventh postoperative day following an uneventful recovery. Histology showed features of massive breast hypertrophy and fibrocystic disease with a fibroadenomatous picture.Figure 2. Late postoperative appearance after amputation mammoplasty with free nipple-areolar graft.Download FigureShe was given bromocryptine 2.5 mg b.i.d. for one year to suppress regrowth. Over a four year period of follow-up, there was no sign of breast enlargement or regrowth. There was some degree of breast sagging which hid the transverse scar across the breast. The patient was very pleased with the results.DISCUSSIONGigantomastia of one or both breasts may occur with an apparently normal hormonal pattern. It consists of hypertrophy of vascular, fibrous, and stromal elements rather than the glandular tissues. The exact causes are poorly understood, but it may be related to progesterone stimulation of the estrogen-primed breast [1–4].The deformity is so disabling that the prime concern is to relieve the patient of the excess breast tissue, which is such a severe physical and mental handicap that her social adjustment may be seriously impaired. Kyphosis, arthritis, submammary intertrigo, chronic mastitis, and cancer phobia are usually associated [1,5,6,9],Massive breast hypertrophy is not easily repaired. In our case, we believed that the ideal treatment was partial mammectomy with breast reconstruction using nipple-areola complex as a free graft. This technique consistently produces well shaped breasts with excellent aesthetic appeal, avoiding the possibility of capsular contraction of prosthetic implants.To prevent recurrence, postoperative adjunctive hormonal therapy has been advocated. Mayl and coworkers [7] reported previous cases in which regrowth occurred after reduction. Therefore, they successfully used dydrogesterone (Gynorest) for one year as an effective progesterone that acts as an anti-estrogen and inhibits growth after reduction mammoplasty. Sperling and Gold [8] reported similar results using medroxy progesterone acetate.Satisfactory results have been achieved in our case with bromocryptine with four years of follow-up without regrowth. The action was thought to be a result of an inhibition of leutinizing hormone, and also due to direct effect of this progesterone on breast tissues. Prolonged amenorrhea may develop as a side effect of medroxy progesterone but it is not usually associated with dydrogesterone. However, we feel that more information is needed before hormonal therapy in gigantomastia can be fully understood.ARTICLE REFERENCES:1. Nolan JJ. "Gigantomastia." Obstet Gyn. 1962: 19:526. Google Scholar2. Gargan JJ, Goldwyn RM. "Gigantomastia complicating pregnancy." Plast Reconstr Surg. 1987; 80:121. Google Scholar3. Goldwyn RM. Problem cases. In: Plastic and reconstructive surgery of the breast. Goldwyn RM, ed. Boston; Little, Brown1976:531-3. Google Scholar4. Stavrides S. "Gigantomastia in pregnancy: a case report." Br J Surg. 1987; 74:585-6. Google Scholar5. Strombeck JO. "Macromastia in women and its surgical treatment: a clinical study based on 1064 cases, (thesis)." Acta Chir Scand. 1964;(suppl)341. Google Scholar6. De Castro, Abowib JH. "Massive breast hypertrophy in a young girl: a case report." Ann Plast Surg. 1990; 25:497-501. Google Scholar7. Mayl N, Vasconez LO, Jurkiewicz MJ. "Treatment of macromastia in actively enlarged breasts." Plast Reconstr Surg. 1974; 54:6. Google Scholar8. Sperling RL, Gold JJ. "Use of an anti-estrogen after a reduction mammoplasty to prevent recurrence of virginal hypertrophy of the breasts." Plast Reconstr Surg. 1973; 52:439. Google Scholar9. Boyce SW, Hoffman PG. "Recurrent macromastia after subcutaneous mastectomy." Am Plast Surg. 1984; 13:511-8. Google Scholar Previous article Next article FiguresReferencesRelatedDetails Volume 13, Issue 5September 1993 Metrics History Accepted7 December 1992Published online1 September 1993 InformationCopyright © 1993, Annals of Saudi MedicinePDF download