The Place of Reductive Surgery in the Management of Gestational Ulcerative Gigantomastia: A Case Report at Sourô Sanou Teaching Hospital

Abstract

Introduction. Gestational gigantomastia is a rare benign disease of unknown cause. We report a case of bilateral gigantomastia in pregnancy in order to locate the place of reductive surgery in its care which is quite controversial. Case. A 25-year-old woman gravida 2 para 1 was referred for an exaggerated bilateral breast enlargement at 32-week gestation. The examination showed bilateral giant breasts with collateral venous circulation and trophic changes marked by the necrosis of the distal third of the mammary skin involving the nipple-areolar complex. She underwent a biopsy of the ulcerative breast tissue, and the histology report did not show a malignant cell. After active foetal lung maturation and induced delivery, a breast reductive surgery with nipple plasty was performed 21 days postpartum. The postoperative course was marked by a period of lymphangitis. The cosmetic and psychological result was satisfactory at 6 months and at 18 months. Conclusion. Gestational gigantomastia is a benign disease that can simulate carcinomatous mastitis. The breast reductive plasty keeps its place in our context.

Gestational gigantomastia with fatal outcome

“…6,9 Patients with GG may develop breast ulceration, hemorrhage, cellulitis, pain, decreased mobility, and can be also be psychologically affected. 6,[10][11][12] The etiology remains unclear; however, it is believed to arise as a result of over-sensitivity or overproduction of pregnancy-related hormones, such as prolactin. 7,13 Alternatively, autoimmunity may also play a role in its pathogenesis; 14 indeed, the simultaneous presence of autoimmune diseases has been reported in several cases.…”

“…6 The main complications in the reported cases of severe GG are associated with skin ulceration, bleeding and necrosis. 6,[9][10][11][12][23][24][25] Indeed, breast ulceration, infection, and bleeding are potentially fatal complications and constitute absolute indications for surgical treatment. Unfortunately, urgent surgical intervention was not feasible in our case due to logistic factors, and the patient died due to hemorrhage.…”

Análise de receptores hormonais de estrógeno e progesterona em hipertrofia mamária versus normomastia, avaliação de presença e densidade com uma nova proposta de classificação das hipertrofias mamárias

“…Ainda em 2019, o que observamos são artigos em sua maioria relatos de caso ainda 88,120 , necessitando a literatura acerca das gigantomastias avançar.…”