Interdisciplinary Approach for the Medical Management of Gestational Gigantomastia

Abstract

Background Gestational gigantomastia is a rare and debilitating condition that is thought to result from hormone hypersensitivity. Several definitions have been proposed using breast weight and change in body mass index, but the breast growth is best summarized as rapid, diffuse, and excessive. Case We report a case of a 31-year-old woman with a history of infertility and cystic fibrosis that developed pathologic breast growth during hormonal preparation for in vitro fertilization. Her serum laboratories were unremarkable, and she was medically managed until 31 weeks of gestation. After delivery, she experienced rapid decrease in breast size and was followed by plastic surgery with plan to allow spontaneous regression with interval breast reduction Conclusion We highlight a successful interdisciplinary medical management approach, which helped to avoid a morbid, intrapartum breast reduction.

Lessons learned in severe axillary gestational gigantomastia

“…Hypertrophied axillary breast tissue during pregnancy can be diagnosed as GG if growth has been rapid and incapacitating, as was the case in our patient 3 . Although the etiology of GG is not well‐established, it has been associated with hormonal hypersensitivity, hyperprolactinemia, and autoimmune disorders, although most patients do not have abnormal bloodwork 2,7,9,10 . Pedicled lipoma is less likely because it is primarily unilateral and less responsive to hormonal stimulation 11 .…”

“…Severe complications have been reported, including tissue necrosis, sepsis, deep vein thrombosis, and hemorrhage from enlarged venous sinuses 2,4–6 . Treatment—which ranges from expectant management to surgical intervention—is individualized for each patient and aims to slow the progression of tissue hypertrophy while relieving symptoms 7 …”

“…In addition to bromocriptine, recent reports now place a greater emphasis on definitive management of GG with surgery. By excising hypertrophied tissue, the symptoms of GG can be reversed and recurrence can be prevented in future pregnancies 4,7 . Axillary hypertrophy is managed with the excision of axillary breast tissue and primary closure.…”

“…Our patient was failing expectant management of her axillary symptoms due to her severe edema and tissue breakdown. Bromocriptine has been shown to arrest further hypertrophy in the peripartum and postpartum period and can be given prophylactically for those with a history of GG 3,7,14 . However, it has not been shown to reverse hypertrophy once it has already begun, which limits its use in patients such as ours with severe symptoms 4,15 …”

“…3 Although the etiology of GG is not well-established, it has been associated with hormonal hypersensitivity, hyperprolactinemia, and autoimmune disorders, although most patients do not have abnormal bloodwork. 2,7,9,10 Pedicled lipoma is less likely because it is primarily unilateral and less responsive to hormonal stimulation. 11 Malignancy is rare but should be ruled out in all patients with imaging.…”