Gigantomastia

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Gigantomastia
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Overview

Overview

Gigantomastia is a rare medical condition where the glandular and/or fatty tissue of the breast becomes excessively enlarged over a relatively short period of time. It is characterized by benign progressive enlargement of the breast tissue which can affect one or both breasts.

The broad term for the condition is breast hypertrophy, and gigantomastia is defined as a breast weight that exceeds 3 percent of the total body weight, or is the combination of normal expected breast tissue weight plus excessive breast tissue weight of more than 2,5 kilograms (5,5 pounds).

Epidemiology

The prevalence of gigantomastia appears to occur in one out of every 100,000 pregnancies.

Etiology

The cause of gigantomastia isn’t clearly understood, but there are various factors that may be involved in the development of the condition. These factors include increased production or elevated sensitivity to certain hormones (estrogen, prolactin and progesterone) and/or growth factors (insulin-like growth factor 1, hepatic growth factor and epidermal growth factor) in the breast tissue.

Certain genetic mutations have been associated with the development of this condition. Increased calcium (as a result of excessive production of parathyroid hormone-related protein) and prolactin levels in the blood stream are also possible causes. Medications that are implicated in the development of gigantomastia include indinavir, ciclosporin, neothetazone, bucillamine and penicillamine.

Giganstomastia can be classified in five different ways: as virginal hypertrophy (where gigantomastia occurs soon after the patient’s first menstruation), gestational (during pregnancy), in association with penicillamine treatment, in association with severe obesity, and in adult women where there’s no obvious cause.

Signs and Symptoms

Signs and symptoms of gigantomastia include the excessive breast tissue mass (as defined), breast pain, and red and itchy lesions. In severe cases, the breast tissue may develop ulcers with possible secondary infections.

The nipples and areolas of the breasts can also be involved. Usually one breast is affected more than the other, which results in breast asymmetry.

Diagnosis

The diagnosis of gigantomastia is suspected on the medical and family history of the patient, together with the findings made on clinical examination.

The cause of the gigantomastia will be confirmed through serological testing to check the mentioned hormonal and electrolyte levels of the patient.

If these tests don’t yield any results, then genetic testing may be performed to look for a genetic cause for the condition.

Management

Gestational gigantomastia has shown to resolve on its own once the pregnancy has ended. If not, then it has shown to be responsive to breast reducing medications such as progesterone, tamoxifen, danazol, testosterone and leuprolide.

Breast surgeries such as reduction mammoplasty and even mastectomies need to be performed when a patient has gigantomastia that doesn’t respond to medical therapies.

If the gigantomastia is associated with increased prolactin levels, then medications such as cabergoline and bromocriptine are indicated.

Gigantomastia that occurs in adolescence is managed by waiting until the breast growth rate has stabilized, and the treatment of choice would then be breast reduction surgery. The reason for this is because the mentioned medications are more risky to use than beneficial for the patient.