Juvenile gigantomastia: subcutaneous mastectomy with primary reconstruction

Jasmina Ivić; Marija Dunjić; Isidora  Tamindžić; Živorad  Kocevski; Boban Djordjević; Boško  Milev

doi:10.2298/VSP200423031I

Jasmina Ivić Military Medical Academy, Clinic for Plastic Surgery and Burns, Belgrade, Serbia
Marija Dunjić Military Medical Academy, Clinic for Plastic Surgery and Burns, Belgrade, Serbia
Isidora Tamindžić Specialized Hospital for Plastic, Aesthetic, and Reconstructive Surgery “MedicOne”, Belgrade, Serbia
Živorad Kocevski Military Medical Academy, Clinic for Plastic Surgery and Burns, Belgrade, Serbia
Boban Djordjević Military Medical Academy, Clinic for Plastic Surgery and Burns, Belgrade, Serbia
Boško Milev University of Defence, Faculty of Medicine of the Military Medical Academy, Belgrade, Serbia

DOI: https://doi.org/10.2298/VSP200423031I

Keywords: gigantomastia, plastic surgery procedures, treatment outcome

Abstract

Introduction. Gigantomastia is one of the most severe anomalies of the female breasts and is caused by their pathological enlargement. Juvenile gigantomastia (JG) of the breasts is a rare disease of an unknown etiology characterized by a sudden and alarmingly rapid, continued growth of the breasts in puberty. Case report. We present two patients with massive bilateral JG. Both patients had normal hormonal status and denied any other health issues, including a positive family history of gigantomastia. The skin overlying the breasts was red, without ulcerations, and with visibly enlarged superficial veins. The nipples were not well defined from the surrounding skin and were positioned below the level of the umbilicus. Patients were successfully treated with a surgical technique consisting of a bilateral subcutaneous mastectomy with the primary reconstruction of the breasts using polyurethane implants and reconstruction of the nipple by the free nipple graft technique. The histopathological reports from both patients’ biopsy specimens presented diffuse hyperplasia of the glandular and stromal tissue. Both patients had excellent esthetic results with minimally visible postoperative scars. Conclusion. Surgical management of JG is the primary means of treatment. This paper presents significant results and effects of plastic surgery, and the applied surgical method can be recommended for the successful management of JG.

References

1. Dieffenbach JF. Die extirpation der bruestdruese. In: Dieffenbach JF, editor. Die Operative Chirurgie. Leipzig: Brockhaus; 1848. p. 359‒73. (German)

2. Wolfswinkel EM, Lemaine V, Weathers WM, Chike-Obi CJ, Xue AS, Heller L. Hyperplastic breast anomalies in the female adolescent breast. Semin Plast Surg 2013; 27(1): 49–55.

3. Zargar AH, Laway BA, Masoodi SR, Chowdri NA, Wani AI. Unilateral gestational macromastia-an unusual presentation of a rare disorder. Postgrad Med J 1999; 75(880): 101‒3.

4. Kupfer D, Dingman D, Broadbent R. Juvenile breast hypertophy: Report of a familial pattern and review of the literature. Plast Reconstr Surg 1992; 90(2): 303‒9.

5. Govrin-Yehudain J, Kogan L, Cohen HI, Falik-Zaccai TC. Familial juvenile hypertrophy of the breast. J Adolesc Health 2004; 35(2): 151‒5.

6. Netscher DT, Mosharrafa AM, Laucirica R. Massive asymmetric virginal breast hypertrophy. South Med J 1996; 89(4): 434‒7.

7. Dafydd H, Roehl KR, Phillips LG, Dancey A, Peart F, Shokrollahi K. Redefining gigantomastia. J Plast Reconstr Aesthet Surg 2011; 64(2): 160‒3.

8. Kulkarni D, Beechey-Newman N, Hamed H, Fentiman IS. Gigantomastia: A problem of local recurrence. Breast 2006; 15(1): 100‒2.

9. Durston W. An extract of a letter written to the publisher from Plymouth Novem. 2. 1669. by William Durston Dr. of Physick; concerning the death of the big-breasted woman (discoursed of in numb. 52.) together with what was thereupon observed in her body. Royal Soc (London) 1669; 4(45‒56): 1068‒9.

10. Zhong A, Wang G, Yang J, Xu Q, Yuan Q, Yang Y, et al. Stromal-epithelial cell interactions and alteration of branching morphogenesis in macromastic mammary glands. J Cell Mol Med 2014; 18(7): 1257‒66.

11. Pülzl P, Schoeller T, Tzankov A, Wechselberger G. Unilateral breast enlargement 5 years after reduction mammaplasty. Aesthetic Plast Surg 2005; 29(5): 404‒6.

12. Wechselberger G, Pülzl P, Pichler M, Schoeller T, Piza-Katzer H. Juvenile gigantomastia treated by reduction mammoplasty. Am J Surg 2004; 188(3): 333‒4.

13. Arscott GD, Craig HR, Gabay L. Failure of bromocriptine therapy to control juvenile mammary hypertrophy. Br J Plast Surg 2001; 54(8): 720‒3.

14. Touraine P, Youssef N, Alyanakian MA, Lechat X, Balleyguier C, Duflos C, et al. Breast inflammatory gigantomastia in a context of immune-mediated diseases. J Clin Endocrinol Metab 2005; 90(9): 5287‒94.

15. Duffy DA, Demers ML, Molin MR. Systemic lupus erythematosus with breast gigantism. J Rheumatol 1995; 22: 1214‒5.

16. Li G, Robinson GW, Lesche R, Martinez-Diaz H, Jiang Z, Rozengurt N, et al. Conditional loss of PTEN leads to precocious development and neoplasia in the mammary gland. Development 2002; 129(17): 4159–70.

17. Koves IH, Zacharin M. Virginal breast hypertrophy of an 11-year-old girl. Journal of paediatrics and child health 2007; 43(4): 315–7.

18. Fusco N, Sajjadi E, Venetis K, Gaudioso G, Lopez G, Corti C, et al. PTEN Alterations and Their Role in Cancer Management: Are We Making Headway on Precision Medicine? Genes (Basel) 2020; 11(7): 719.

19. Mosteller RD. Simplified calculation of body-surface area. N Engl J Med 1987; 317(17): 1098.

20. Güneş D, Mutafoğlu-Uysal K, Canda T, Saydam S, Cemeroğlu AP, Olgun N. Unilateral juvenile (virginal) hypertrophy of the breast. Turk J Pediatr 2008; 50(3): 278‒81.

21. Hoppe IC, Patel PP, Singer-Granick CJ, Granick MS. Virginal mammary hypertrophy: a meta-analysis and treatment algorithm. Plast Reconstr Surg 2011; 127(6): 2224‒31.

22. Fiumara L, Gault DT, Nel MR, Lucas DN, Courtauld E. Massive bilateral breast reduction in an 11-year-old girl: 24% ablation of body weight. J Plast Reconstr Aesthet Surg 2009; 62(8): e263‒6.

23. Hisham A, Abd Latib M, Basiron N. Juvenile Breast Hypertrophy: A Successful Breast Reduction of 14.9% Body Weight without Recurrence in a 5-Year Follow-Up. Case Rep Surg 2017; 2017: 3491012.

24. Qin F, Si L, Zhang H, Zhang M, Zeng A, Long F, et al. Management of gestational gigantomastia with breast reconstruction after mastectomy: case report and literature review. J Int Med Res 2020; 48(6): 300060520920463.

25. Pruthi S, Jones KN. Nonsurgical management of fibroadenoma and virginal breast hypertrophy. Semin Plast Surg 2013; 27(1): 62‒6.

26. Barton MB, West CN, Liu IL, Harris EL, Rolnick SJ, Elmore JG, et al. Complications following bilateral prophylactic mastectomy. J Natl Cancer Inst Monogr 2005; (35): 61‒6.