{{Short description|Rare human disease}} {{Infobox medical condition (new) | name = Breast hypertrophy | synonyms = | field = Gynecology, endocrinology | caption = A case of breast hypertrophy at Komfo Anokye Teaching Hospital, Ghana | pronounce = | alt = Adult man with hypertrophy of both breasts | width = 175px | symptoms = Excessively large breast tissue | complications = | onset = | duration = | types = Macromastia <br> Gigantomastia | causes = | risks = Increased levels or heightened sensitivity to certain hormones and/or growth factors | diagnosis = | differential = | prevention = | treatment = | medication = | prognosis = | frequency = | deaths = }}
'''Breast hypertrophy''' is a rare medical condition of the breast connective tissues in which the breasts become excessively large. The condition is often divided based on the severity into two types, '''macromastia''' and '''gigantomastia'''. Hypertrophy of the breast tissues may be caused by increased histologic sensitivity to certain hormones such as female sex hormones, prolactin, and growth factors.<ref name=ohlsen>{{cite journal |doi=10.1007/BF00180324 |title=Rapid, massive and unphysiological breast enlargement |year=1996 |last1=Ohlsén |first1=L. |last2=Ericsson |first2=O. |last3=Beausang-Linder |first3=M. |journal=European Journal of Plastic Surgery |volume=19 |issue=6|s2cid=19355441 }}</ref> Breast hypertrophy is a benign ''progressive'' enlargement, which can occur in both breasts (bilateral) or only in one breast (unilateral). It was first scientifically described in 1648.<ref>{{citation |first=T|last=Palmuth |title=Observations medicuarum centinae tres posthumae|publisher=Braunschweig |year=1648|volume=Cent II|issue=Obs 89}}</ref>
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==Description and types== The indication is a total breast weight that exceeds approximately 3% of the total body weight.<ref name=dafydd>{{cite journal |doi=10.1016/j.bjps.2010.04.043 |title=Redefining gigantomastia |year=2011 |last1=Dafydd |first1=H. |last2=Roehl |first2=K.R. |last3=Phillips |first3=L.G. |last4=Dancey |first4=A. |last5=Peart |first5=F. |last6=Shokrollahi |first6=K. |journal=Journal of Plastic, Reconstructive & Aesthetic Surgery |volume=64 |issue=2 |pages=160–3 |pmid=20965141}}</ref> There are varying definitions of what is considered to be excessive breast tissue, that is the expected breast tissue plus extraordinary breast tissue, ranging from as little as {{convert|0.6|kg|lb}} up to {{convert|2.5|kg|lb}} with most physicians defining macromastia as excessive tissue of over {{convert|1.5|kg|lb}}. Some resources distinguish between '''macromastia''' (Greek, ''macro'': large, ''mastos'': breast), where excessive tissue is less than 2.5 kg, and '''gigantomastia''' (Greek, ''gigantikos'': giant), where excessive tissue is more than 2.5 kg.<ref>{{cite book|author=To Wo Chiu|year=2011|title=Stone's Plastic Surgery Facts and Figures|publisher=Cambridge University Press|edition=3rd|page=188}}</ref><ref name="HodaBrogi2014">{{cite book|author1=Syed A. Hoda|author2=Edi Brogi|author3=Fred Koerner|author4=Paul Peter Rosen|title=Rosen's Breast Pathology|url=https://books.google.com/books?id=h2DMAgAAQBAJ&pg=PT152|date=5 February 2014|publisher=Wolters Kluwer Health|isbn=978-1-4698-7070-0|pages=152–}}</ref> The enlargement can cause muscular discomfort and over-stretching of the skin envelope, which can lead in some cases to ulceration.<ref name=sharma>Note: the criterion of >600g is used with the term "macromastia" in this source: {{cite journal |pmid=16329566 |year=2004 |last1=Sharma |first1=K |last2=Nigam |first2=S |last3=Khurana |first3=N |last4=Chaturvedi |first4=KU |title=Unilateral gestational macromastia--a rare disorder |volume=26 |issue=2 |pages=125–8 |journal=The Malaysian Journal of Pathology}}</ref>
Hypertrophy of the breast can affect the breasts equally, but usually affects one breast more than the other, thereby causing asymmetry, when one breast is larger than the other. The condition can also individually affect the nipples and areola instead of or in addition to the entire breast. The effect can produce a minor size variation to an extremely large breast asymmetry. Breast hypertrophy is classified in one of five ways: as either pubertal (juvenile hypertrophy), gestational (gravid macromastia), in adult women without any obvious cause, associated with penicillamine therapy, and associated with extreme obesity.<ref name=sharma/> Many definitions of macromastia and gigantomastia are based on the term of "excessive breast tissue", and are therefore somewhat arbitrary.
A total of 115 cases of gigantomastia had been reported in the literature as of 2008.<ref name="DanceyKhan2008">{{cite journal|last1=Dancey|first1=Anne|last2=Khan|first2=M.|last3=Dawson|first3=J.|last4=Peart|first4=F.|title=Gigantomastia – a classification and review of the literature|journal=Journal of Plastic, Reconstructive & Aesthetic Surgery|volume=61|issue=5|year=2008|pages=493–502|issn=1748-6815|doi=10.1016/j.bjps.2007.10.041|pmid=18054304}}</ref>
===Juvenile breast hypertrophy=== When gigantomastia occurs in pubescent females, the medical condition is known as ''juvenile macromastia'' or ''juvenile gigantomastia'' and sometimes as ''virginal breast hypertrophy'' or ''virginal mammary hypertrophy'' although the term ''virginal'' is now considered misleading and outdated. Along with the excessive breast size, other symptoms include red, itchy lesions and pain in the breasts. A diagnosis is made when an adolescent's breasts grow rapidly and achieve great weight, usually soon after their first menstrual period. Some doctors suggest that the rapid breast development occurs before the onset of menstruation.<ref>{{cite web | url=http://www.obgyn.net/yw/yw.asp?page=/yw/puberty_QnA | title=Puberty Stages of Development | work=Ask the Expert FAQs | publisher=OBGYN.net | access-date=2006-11-21 | url-status=dead | archive-url=https://web.archive.org/web/20060502072110/http://www.obgyn.net/yw/yw.asp?page=%2Fyw%2Fpuberty_QnA | archive-date=2006-05-02 }}</ref>
Some adolescents with juvenile breast hypertrophy experience breast growth at a steady rate for several years, after which the breasts rapidly develop exceeding normal growth. Some adolescent females experience minimal or negligible breast growth until their breasts suddenly grow very rapidly in a short period of time. This may cause considerable physical discomfort. Individuals with JBH often experience an excessive growth of their nipples as well. In severe cases of JBH, clitoromegaly occurs.{{Citation needed|date=November 2009}}
At the onset of puberty, some females who have experienced little or no breast development can reportedly reach three or more cup sizes within a few days (see below).<ref name="Casciola2009">{{cite journal|url=http://www.llli.org/llleaderweb/LV/LVJunJul05p62.html| title=Gigantomastia|first=Cheri| last=Casciola|location=Chandler, Arizona|journal=Leaven|volume=41|issue=3|date=June–July 2005|pages=62–63|access-date=October 26, 2009 |archive-url=https://web.archive.org/web/20171004203403/http://www.llli.org/llleaderweb/LV/LVJunJul05p62.html |archive-date=October 4, 2017}}</ref>
As of 1992, 70 cases of juvenile breast hypertrophy had been reported.<ref name="pmid1631223">{{cite journal | vauthors = Kupfer D, Dingman D, Broadbent R | title = Juvenile breast hypertrophy: report of a familial pattern and review of the literature | journal = Plast. Reconstr. Surg. | volume = 90 | issue = 2 | pages = 303–9 | date = August 1992 | pmid = 1631223 | doi = 10.1097/00006534-199290020-00023}}</ref>
===Gestational breast hypertrophy=== This same effect can also occur at the onset of pregnancy or between the 16th to 20th week of gestation. When the swelling in the connective tissue occurs after birth, it can negatively impact long term milk supply.<ref name="Casciola2009"/> The swelling increases with each subsequent pregnancy.
The extremely rapid growth of the breasts can result in intense heat. The woman's breasts can generate extraordinary discomfort, turning feverish, red, itchy, and even causing the skin to peel. The swelling can suppress the milk supply, pinching off the milk ducts, and leading to mastitis.<ref name="Casciola2009"/>
Gestational gigantomastia is estimated to occur in 1 out of every 28,000 to 100,000 pregnancies.<ref name="RezaiNakagawa2015">{{cite journal|last1=Rezai|first1=Shadi|last2=Nakagawa|first2=Jenna T.|last3=Tedesco|first3=John|last4=Chadee|first4=Annika|last5=Gottimukkala|first5=Sri|last6=Mercado|first6=Ray|last7=Henderson|first7=Cassandra E.|title=Gestational Gigantomastia Complicating Pregnancy: A Case Report and Review of the Literature|journal=Case Reports in Obstetrics and Gynecology|volume=2015|year=2015|pages=1–10|issn=2090-6684|doi=10.1155/2015/892369|pmc=4680110|pmid=26713166| doi-access=free }}</ref><ref name=juan>{{cite web|url=https://www.theregister.co.uk/2007/01/13/the_odd_body_gigantomastia/|title=Is it true that a woman's breasts can grow enormously overnight?|last=Juan, Ph.D. |first=Stephen|date=January 13, 2007|publisher=The Register U.K.|access-date=2011-08-16 }}</ref>
Breast size in women with gestational breast hypertrophy typically reverts to approximately pre-pregnancy size or near it after pregnancy and cessation of breastfeeding.<ref name="pmid16980844">{{cite journal | vauthors = Swelstad MR, Swelstad BB, Rao VK, Gutowski KA | title = Management of gestational gigantomastia | journal = Plast. Reconstr. Surg. | volume = 118 | issue = 4 | pages = 840–8 | date = September 2006 | pmid = 16980844 | doi = 10.1097/01.prs.0000232364.40958.47 | s2cid = 21477770 }}</ref><ref name="pmid5635401">{{cite journal | vauthors = Moss WM | title = Gigantomastia with pregnancy. A case report with review of the literature | journal = Arch Surg | volume = 96 | issue = 1 | pages = 27–32 | date = January 1968 | pmid = 5635401 | doi = 10.1001/archsurg.1968.01330190029007 }}</ref><ref name="pmid4136526">{{cite journal | vauthors = van der Meulen AJ | title = An unusual case of massive hypertrophy of the breasts | journal = S. Afr. Med. J. | volume = 48 | issue = 34 | pages = 1465–6 | date = July 1974 | pmid = 4136526 }}</ref> This is not always the case however and in some only partial reduction in breast size may occur, necessitating surgical breast reduction.<ref name="pmid9059749">{{cite journal | vauthors = Cheung KL, Alagaratnam TT | title = Pregnancy-related gigantomastia. Case report | journal = Arch. Gynecol. Obstet. | volume = 259 | issue = 2 | pages = 87–9 | date = 1997 | pmid = 9059749 | doi = 10.1007/bf02505314 | s2cid = 19285744 }}</ref><ref name="Dewhurst1972">{{cite book | author = C. J. Dewhurst | chapter = Miscellaneous Disorders Complicating Pregnancy | pages = 334–352 | editor = C. J. Dewhurst | title = Integrated Obstetrics and Gynaecology for Postgraduates | year = 1981 | edition = 1 | publisher = Blackwell Scientific Publications | isbn = 9780632006847 | oclc = 8252620 | quote = The reduction in size of the breasts after delivery [in women with massive breast enlargement of pregnancy] may be incomplete and the patient may be left with very large breasts indeed, for which plastic surgical treatment should be considered.}}</ref>
===Other types of breast hypertrophy=== Only 15% of cases of breast hypertrophy are unrelated to puberty or pregnancy.<ref name="DasRai2019" /> Other types and causes of breast hypertrophy include idiopathic, drug-induced (e.g., penicillamine, ciclosporin, bucillamine), autoimmunity-associated, tumors, and syndromes.<ref name="DasRai2019">{{cite journal|last1=Das|first1=Liza|last2=Rai|first2=Ashutosh|last3=Vaiphei|first3=Kim|last4=Garg|first4=Akhil|last5=Mohsina|first5=Subair|last6=Bhansali|first6=Anil|last7=Dutta|first7=Pinaki|last8=Tripathy|first8=Satyaswarup|title=Idiopathic gigantomastia: newer mechanistic insights implicating the paracrine milieu|journal=Endocrine|volume=66|issue=2|year=2019|pages=166–177|issn=1355-008X|doi=10.1007/s12020-019-02065-x|pmid=31502211|s2cid=201989138}}</ref> Two case reports of prepubertal breast hypertrophy, both in infants, have been reported.<ref name="Merlob2018">{{cite book|last1=Merlob|first1=Paul|title=Nipple-Areolar Complex Reconstruction|chapter=Congenital Malformations and Developmental Changes of the Breast: A Dysmorphological View|year=2018|pages=31–45|doi=10.1007/978-3-319-60925-6_2|isbn=978-3-319-60924-9}}</ref><ref name="MickMcCormick1991">{{cite journal|last1=Mick|first1=G. J.|last2=McCormick|first2 =K. L.|last3=Wakimoto|first3=H.|title=Massive breast enlargement in an infant girl with central nervous system dysfunction|journal=European Journal of Pediatrics|volume=150|issue=3|year=1991|pages=154–157|issn=0340-6199|doi=10.1007/BF01963555|pmid=2044582|s2cid=24172907}}</ref><ref name="ZinnHaller1999">{{cite journal|last1=Zinn|first1=Harry L.|last2=Haller|first2=J. O.|last3=Kedia|first3=Sanjay|title=Macromastia in a newborn with Alagille syndrome|journal=Pediatric Radiology|volume=29|issue=5|year=1999|pages=331–333|issn=0301-0449|doi=10.1007/s002470050601|pmid=10382209|s2cid=21758333}}</ref>
==Causes== The underlying cause of the rapidly growing breast connective tissue, resulting in gigantic proportions, has not been well elucidated. However, proposed factors have included increased levels/expression of or heightened sensitivity to certain hormones (e.g., estrogen, progesterone, and prolactin)<ref name="pmid11899849">{{cite journal | vauthors = Noczyńska A, Wasikowa R, Myczkowski T | title = [Hypersensitivity of estrogen receptors as a cause of gigantomasty in two girls] | language = pl | journal = Pol. Merkur. Lekarski | volume = 11 | issue = 66 | pages = 507–9 | year = 2001 | pmid = 11899849 }}</ref> and/or growth factors (e.g., hepatocyte growth factor, insulin-like growth factor 1, and epidermal growth factor) in the breasts.<ref name="ZhongWang2014">{{cite journal|last1=Zhong|first1=Aimei|last2=Wang|first2=Guohua|last3=Yang|first3=Jie|last4=Xu|first4=Qijun|last5=Yuan|first5=Quan|last6=Yang|first6=Yanqing|last7=Xia|first7=Yun|last8=Guo|first8=Ke|last9=Horch|first9=Raymund E.|last10=Sun|first10=Jiaming|title=Stromal-epithelial cell interactions and alteration of branching morphogenesis in macromastic mammary glands|journal=Journal of Cellular and Molecular Medicine|volume=18|issue=7|year=2014|pages=1257–1266|issn=1582-1838|doi=10.1111/jcmm.12275|pmid=24720804|pmc=4124011}}</ref><ref name="KulkarniBeechey-Newman2006">{{cite journal|last1=Kulkarni|first1=Dhananjay|last2=Beechey-Newman|first2=N.|last3=Hamed|first3=H.|last4=Fentiman|first4=I.S.|title=Gigantomastia: A problem of local recurrence|journal=The Breast|volume=15|issue=1|year=2006|pages=100–102|issn=0960-9776|doi=10.1016/j.breast.2005.03.002|pmid=16005231}}</ref> Macromastic breasts are reported to be composed mainly of adipose and fibrous tissue, while glandular tissue remains essentially stable.<ref name="MoschellaCordova2016" />
Macromastia occurs in approximately half of women with aromatase excess syndrome (a condition of hyperestrogenism).<ref name="ShozuFukami2014">{{cite journal|last1=Shozu|first1=Makio|last2=Fukami|first2=Maki|last3=Ogata|first3=Tsutomu|title=Understanding the pathological manifestations of aromatase excess syndrome: lessons for clinical diagnosis|journal=Expert Review of Endocrinology & Metabolism|volume=9|issue=4|year=2014|pages=397–409|issn=1744-6651|doi=10.1586/17446651.2014.926810|pmc=4162655|pmid=25264451}}</ref><ref name="MartinLin2003">{{cite journal|last1=Martin|first1=Regina M.|last2=Lin|first2=Chin J.|last3=Nishi|first3=Mirian Y.|last4=Billerbeck|first4=Ana Elisa C.|last5=Latronico|first5=Ana Claudia|last6=Russell|first6=David W.|last7=Mendonca|first7=Berenice B.|title=Familial Hyperestrogenism in Both Sexes: Clinical, Hormonal, and Molecular Studies of Two Siblings|journal=The Journal of Clinical Endocrinology & Metabolism|volume=88|issue=7|year=2003|pages=3027–3034|issn=0021-972X|doi=10.1210/jc.2002-021780|pmid=12843139|doi-access=}}</ref> Hyperprolactinaemia has been reported as a cause of some cases of macromastia.<ref name="pmid20348982">{{cite journal | vauthors = Rahman GA, Adigun IA, Yusuf IF | title = Macromastia: a review of presentation and management | journal = Niger Postgrad Med J | volume = 17 | issue = 1 | pages = 45–9 | year = 2010 | doi = 10.4103/1117-1936.181422 | pmid = 20348982 | s2cid = 5742903 | doi-access = free }}</ref><ref name="DellalOzdemir2016">{{cite journal|last1=Dellal|first1=Fatma Dilek|last2=Ozdemir|first2=Didem|last3=Aydin|first3=Cevdet|last4=Kaya|first4=Gulfem|last5=Ersoy|first5=Reyhan|last6=Cakir|first6=Bekir|title=Gigantomastia and Macroprolactinemia Responding to Cabergoline Treatment: A Case Report and Minireview of the Literature|journal=Case Reports in Endocrinology|volume=2016|year=2016|pages=1–5|issn=2090-6501|doi=10.1155/2016/3576024|pmc=4852364|pmid=27195157| doi-access=free }}</ref> Macromastia has also been associated with hypercalcaemia (which is thought to be due to excessive production of parathyroid hormone-related protein) and, rarely, systemic lupus erythematosus<ref name="MoschellaCordova2016">{{cite book|last1=Moschella|first1=Francesco|last2=Cordova|first2=Adriana|last3=Toia|first3=Francesca|chapter=Gigantomastia |title=International Textbook of Aesthetic Surgery|year=2016|pages=239–245|doi=10.1007/978-3-662-46599-8_18|isbn=978-3-662-46598-1}}</ref> and pseudoangiomatous stromal hyperplasia.<ref name="RoyLee2015">{{cite journal|last1=Roy|first1=Mélissa|last2=Lee|first2=James|last3=Aldekhayel|first3=Salah|last4=Dionisopoulos|first4=Tassos|title=Pseudoangiomatous Stromal Hyperplasia|journal=Plastic and Reconstructive Surgery Global Open|volume=3|issue=9|year=2015|pages=e501|issn=2169-7574|doi=10.1097/GOX.0000000000000468|pmid=26495214|pmc=4596426}}</ref> It is also notable that approximately two-thirds of women with macromastia are obese.<ref name="MoschellaCordova2016" /> Aside from aromatase (as in aromatase excess syndrome), at least two other genetic mutations (one in PTEN, the other "MDNS" not yet located to gene level) have been implicated in causing macromastia.<ref name="pmid12163417">{{cite journal | vauthors = Li G, Robinson GW, Lesche R, Martinez-Diaz H, Jiang Z, Rozengurt N, Wagner KU, Wu DC, Lane TF, Liu X, Hennighausen L, Wu H | title = Conditional loss of PTEN leads to precocious development and neoplasia in the mammary gland | journal = Development | volume = 129 | issue = 17 | pages = 4159–70 | year = 2002 | doi = 10.1242/dev.129.17.4159 | pmid = 12163417 }}</ref><ref name="Genzer-NirKhayat2010">{{cite journal|last1=Genzer-Nir|first1=Mira|last2=Khayat|first2=Morad|last3=Kogan|first3=Leonid|last4=Cohen|first4=Hector I|last5=Hershkowitz|first5=Miriam|last6=Geiger|first6=Dan|last7=Falik-Zaccai|first7=Tzipora C|title=Mammary-digital-nail (MDN) syndrome: a novel phenotype maps to human chromosome 22q12.3–13.1|journal=European Journal of Human Genetics|volume=18|issue=6|year=2010|pages=662–667|issn=1018-4813|doi=10.1038/ejhg.2009.236|pmid=20145678|pmc=2987341}}</ref>
A handful of drugs have been associated with gigantomastia, including penicillamine, bucillamine, neothetazone, ciclosporin, indinavir, and prednisolone.<ref name="MoschellaCordova2016" /><ref name="Dabbs2012">{{cite book|author=David J. Dabbs|title=Breast Pathology|url=https://books.google.com/books?id=53CN1aUnAOUC&pg=PA19|year=2012|publisher=Elsevier Health Sciences|isbn=978-1-4377-0604-8|pages=19–}}</ref><ref>{{Cite journal|last1=Jabaiti|first1=Samir|last2=Fayyad|first2=Luma|last3=Isleem|first3=Ula|date=2019-01-01|title=Prednisolone-induced virginal mammary hypertrophy: Case report|journal=International Journal of Surgery Case Reports|volume=59|pages=140–143|doi=10.1016/j.ijscr.2019.04.042|pmid=31146195|pmc=6541761|issn=2210-2612|doi-access=free}}</ref>
==Treatment== Medical treatment has not proven consistently effective. Medical regimens have included tamoxifen,<ref name="pmid11352426">{{cite journal |doi=10.1097/00000637-200105000-00011 |title=Juvenile Gigantomastia: Presentation of Four Cases and Review of the Literature |year=2001 |last1=Baker |first1=Stephen B. |last2=Burkey |first2=Brooke A. |last3=Thornton |first3=Paul |last4=Larossa |first4=Don |journal=Annals of Plastic Surgery |volume=46 |issue=5 |pages=517–25; discussion 525–6 |pmid=11352426|s2cid=13015277 }}</ref> progesterone, bromocriptine, the gonadotropin-releasing hormone agonist leuprorelin, and testosterone. Gestational macromastia has been treated with breast reduction drugs alone without surgery.<ref>{{cite journal |doi=10.1136/bcr.01.2010.2632 |title=Gestational gigantomastia with complete resolution in a Nigerian woman |year=2011 |last1=Ezem |first1=B. U. |last2=Osuagwu |first2=C. C. |last3=Opara |first3=K. A. |journal=BMJ Case Reports |volume=2011 |pages=bcr0120102632 |pmid=22707463 |pmc=3062818}}</ref> Surgical therapy includes reduction mammaplasty and mastectomy.<ref>{{cite journal |doi=10.1111/j.1524-4741.2008.00628.x |title=Gestational Macromastia: A Medical and Surgical Challenge |year=2008 |last1=Bloom |first1=Sara A. |last2=Nahabedian |first2=Maurice Y. |journal=The Breast Journal |volume=14 |issue=5 |pages=492–5 |pmid=18657144|s2cid=29713936 |doi-access=free }}</ref> However, breast reduction is not clinically indicated unless at least {{Convert|1.8|kg|lb}} of tissue per breast needs to be removed.<ref name="KulkarniBeechey-Newman2006"/> In the majority of cases of macromastia, surgery is medically unnecessary, depending on body height. Topical treatment includes regimens of ice to cool the breasts.<ref name="Casciola2009"/>
Treatment of hyperprolactinemia-associated macromastia with D<sub>2</sub> receptor agonists such as bromocriptine and cabergoline has been found to be effective in some, but not all cases.<ref name="DellalAydin2014">{{cite journal|last1=Dellal|first1=Fatma Dilek|last2=Aydin|first2=Cevdet|last3=Kaya|first3=Mina Gulfem|last4=Ersoy|first4=Reyhan|last5=Cakir|first5=Bekir|title=A case with macroprolactinemia and gigantomastia responding to cabergoline treatment|journal=Endocrine Abstracts|year=2014|issn=1479-6848|doi=10.1530/endoabs.35.P878}}</ref><ref name="pmid11728119">{{cite journal | vauthors = Arscott GD, Craig HR, Gabay L | title = Failure of bromocriptine therapy to control juvenile mammary hypertrophy | journal = Br J Plast Surg | volume = 54 | issue = 8 | pages = 720–3 | year = 2001 | pmid = 11728119 | doi = 10.1054/bjps.2001.3691 | doi-access = free }}</ref> Danazol, an antiestrogen and weak androgen, has also been found to be effective in the treatment of macromastia.<ref name="JatoiKaufmann2010">{{cite book|author1=Ismail Jatoi|author2=Manfred Kaufmann|title=Management of Breast Diseases|url=https://books.google.com/books?id=nsUBW3-qJ9MC&pg=PA47|date=11 February 2010|publisher=Springer Science & Business Media|isbn=978-3-540-69743-5|pages=47–}}</ref>
When hypertrophy occurs in adolescence, noninvasive treatments, including pharmaceutical treatment, hormone therapy, and steroid use are not usually recommended due to known and unknown side effects.{{cn|date=May 2025}} Once breast growth rate has stabilized, breast reduction may be an appropriate choice. In some instances after aggressive or surgical treatment, the breast may continue to grow or re-grow, a complete mastectomy may be recommended as a last resort.
Pregnancy is recognized as the second most common reason for hypertrophy. When secondary to pregnancy, it may resolve itself without treatment after the pregnancy ends.<ref name="pmid16980844"/>
==Society and culture==
===Difficulties=== Extremely large breasts are a source of considerable attention.<ref>{{Cite web|url=https://www.vice.com/en/article/the-size-of-my-boobs-never-let-me-have-the-body-i-wanted/|title=The Size of My Breasts Never Let Me Have the Body I Wanted|last1=Stoller|first1=Evy Pitt|last2=Geisinger|first2=Gabriella|date=2018-02-23|website=Tonic|language=en-US|access-date=2019-04-01}}</ref><ref>{{Cite web|url=https://fairygodboss.com/articles/breast-size-affects-my-career|title=I'm Sick Of The Way My Breast Size Affects My Career|first1=AnnaMarie|last1=Houlis|website=Fairygodboss|language=en|access-date=2019-04-01}}</ref><ref>{{Cite news|url=https://www.nytimes.com/2019/03/06/well/move/how-breast-size-affects-how-women-exercise.html|title=How Breast Size Affects How Women Exercise|last=Reynolds|first=Gretchen|date=2019-03-06|work=The New York Times|access-date=2019-04-01|language=en-US|issn=0362-4331}}</ref><ref>{{Cite news|url=https://madamenoire.com/291138/breasts-are-a-love-hate-thing-just-because-theyre-visible-doesnt-mean-we-should-be-friends/|title=A Love-Hate Relationship: My Large Chest And The Negative Attention That Comes With It|last=Ellis|first=Stacy Ann|date=2013-08-22|website=MadameNoire|access-date=2019-04-01}}</ref> Some women try to hide or mask their breasts with special clothing, including minimizing bras or breast binding clothing. Women with this condition may be subject to psychological problems due to unwanted attention or harassment. Depression is common in those affected.
In the case of a 12-year-old Japanese girl reported in 1993, her "massively enlarged" breasts caused her "intense psychological problems, incapacitating her in school activities and social relations".<ref name=morimoto/> Actress Soleil Moon Frye, who starred as a child in the sitcom ''Punky Brewster'', reported in an interview with ''People'' magazine that boys taunted her, calling her "Punky Boobster". It affected her professional and social life negatively. "People started to think of me as a bimbo," she said in the interview. "I couldn't sit up straight without people looking at me like I was a prostitute{{interp|.}}" She had breast reduction surgery at the age of 15.<ref name=people>{{cite web|url=https://www.people.com/people/archive/article/0,,20110250,00.html|title=Now I Can Be Free|last=Rosen|first=Marjorie |date=April 26, 1993 |work=Vol. 39, No. 16|publisher=People Magazine|access-date=2009-09-12}}</ref>
Finding large bra sizes and styles that fit is challenging. Also, larger bras are more costly, challenging to find, and unflattering to the wearer. Ill-fitting bras with narrow straps can cause chronic irritation, redness, and indentations in the shoulders. Skin rashes under the breasts are common, particularly during warm weather. Heavy breasts may cause headaches, neck pain, upper and lower back pain, and numbness or tingling in the fingers. There is a possible connection between macromastia and carpal-tunnel-syndrome.<ref>{{Cite journal| issn = 1432-5241| volume = 30| issue = 5| pages = 535–537| last1 = Iwuagwu| first1 = Obi| last2 = Bajalan| first2 = Ahmed| last3 = Platt| first3 = Alastair| last4 = Stanley| first4 = Paul| last5 = Reese| first5 = Richard| last6 = Drew| first6 = Philip| title = Macromastia and Carpal Tunnel Syndrome: Is There an Association?| journal = Aesthetic Plastic Surgery| date = 2006-10-01| doi = 10.1007/s00266-005-0214-x| pmid = 16858658| s2cid = 189870808}}</ref>{{Better source needed|reason=Small study from primary source|date=December 2021}}
===Medical insurance coverage=== Insurance companies in the United States typically require the physician to provide evidence that a woman's large breasts cause headaches or back and neck pain before they will pay for breast reduction. Insurance companies also mandate a woman who is overweight, which is often the case with gigantomastia, to first lose a certain amount of weight. They also commonly require the patient to try alternative treatments like physical therapy for a year or more.<ref name="seattlewomanmagazine.com">{{cite web|url=http://www.seattlewomanmagazine.com/articles/oct06-2.htm |title=Too Much of a Good Thing? |publisher=Seattle Woman Magazine |access-date=2013-03-14}}</ref>
===Reported instances===
====Gigantomastia==== [[Image:Durston gigantomastia 1670.png|thumb|left|The first recorded case of gigantomastia, diagnosed in a 23- or 24-year-old Elizabeth Travers, 1669. In 1669, the physician William Durston drew this illustration of the first recorded case of non-gravid gigantomastia.]]
The earliest description and illustration of gigantomastia dates to 1669.<ref>{{Citation |last1=Fahmy |first1=Fahmy S. |title=Reduction Mammoplasty: "The Piece of Art" |date=2013 |work=Cosmetic Surgery: Art and Techniques |pages=755–774 |editor-last=Shiffman |editor-first=Melvin A. |url=https://link.springer.com/chapter/10.1007/978-3-642-21837-8_45 |access-date=2024-08-21 |place=Berlin, Heidelberg |publisher=Springer |language=en |doi=10.1007/978-3-642-21837-8_45 |isbn=978-3-642-21837-8 |last2=Saleh |first2=Mohamed Ahmed Amin |editor2-last=Di Giuseppe |editor2-first=Alberto|url-access=subscription }}</ref> In July of that year the Plymouth physician William Durston wrote to the Royal Society, reporting the case of a patient named Elizabeth Travers. Durston's account was soon published in the Society's ''Philosophical Transactions'', and includes the following account of the onset of symptoms:<blockquote>Elizabeth Treves, [sic] 23. or 24. years of age, fair of complexion, brown-hair'd, of an healthy constitution, low of stature, of honest repute, but of mean and poor parentage, near this Town [Plymouth], was on Friday July 3d, 1669 in good health, and went well to bed, where she took as good rest and sleep, as ever before, but in the morning, when she awaken'd, and attempted to turn herself in her bed, was not able, finding her Breasts so swell'd, that she was affrighted to an astonishment. Then endeavoring to sit up, the weight of her Breasts fastned her to her bed; where she hath layn ever since, yet without all pain and weakness either in her Breasts, or in any other part.<ref name=":0">{{Cite journal |last=Meli |first=Nico Bertoloni |date=2015 |title=Visual Representations of Disease: The Philosophical Transactions and William Cheselden's Osteographia |url=https://muse.jhu.edu/article/610800 |journal=Huntington Library Quarterly |volume=78 |issue=2 |pages=157–186 |doi=10.1353/hlq.2015.0026 |issn=1544-399X|url-access=subscription }}</ref></blockquote>Durston later wrote to the Society to report that Travers had died on October 21 of the same year, four months after the onset of enlargement. One breast removed after the woman's death weighed {{cvt|64|lb}}. Durston had attempted to treat Travers with salivation, which he believed reduced her breasts slightly but which she did not like as a treatment option, and then cauterization followed by incision by knife in the hope that excess fluid would be found to drain, but this was unsuccessful as it was healthy breast tissue, notable only for its massive enlargement and thus lacking excess fluid to drain.<ref name="durston">{{cite journal |doi=10.1098/rstl.1669.0048 |title=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 Bigg-Breasted Woman (Discoursed of in Numb. 52.) Together with what Was thereupon Observed in Her Body |year=1669 |last1=Durston |first1=W. |last2=Darston |first2=W. |journal=Philosophical Transactions of the Royal Society |volume=4 |issue=45–56 |pages=1068–1069|bibcode=1669RSPT....4.1068D |doi-access=free }}</ref>
[[Image:1848 lam aua hypertrophy.jpg|thumb|A painting by Lam Qua of Lu-shi, age 42, on April 17, 1848, prior to breast reduction surgery]]
On April 17, 1848, a 42-year-old woman named Lu-shi was treated for hypertrophy in a Chinese hospital. She was treated by a missionary physician. On December 24, 1849, the left breast, measuring {{cvt|67|cm}} in circumference, and weighing {{cvt|2.7|kg}}, was removed in a procedure lasting three and a half minutes. The right breast was removed one month later. It measured {{cvt|61|cm}} in circumference and weighed {{cvt|2.5|kg}}.<ref>{{cite web|url=http://www.med.yale.edu/library/historical/parker/lamqua16.html|title=Peter Parker Collection|last=Qua|first=Lam|author-link=Lam Qua|date=April 17, 1848|work=Medical Historical Library, Cushing/Whitney Medical Library|access-date=21 March 2010|url-status=dead|archive-url=https://web.archive.org/web/20090813123633/http://www.med.yale.edu/library/historical/parker/lamqua16.html|archive-date=13 August 2009}}</ref>
In 2005, a woman reported that her breasts grew at puberty from nothing to a C cup in one month. When she became pregnant for the first time, her breasts increased two cup sizes in a few days. Immediately after her first birth, her breasts grew three cup sizes. After her second child was born, her breasts increased six cup sizes. After her third childbirth, they grew ten cup sizes, and after her fourth child was born, they grew nine cup sizes. In this instance, the swelling abated about 10 days after childbirth, but her bra cup size remained E to a G for the next year. About one year postpartum, her breasts rapidly atrophied to AA cup size.<ref name="Casciola2009"/>
One of the most severe cases of macromastia was reported from Ilorin in Nigeria. In 2007, Ganiyu Adebisi Rahman and his colleagues reported the case of a 26-year-old woman who presented with massive swelling of her breasts and bilateral axillary swellings of 6 years duration. Rahman led a team of surgeons in Ilorin to perform a total bilateral excision of the hypertrophied axillary breasts, and bilateral breast amputation with composite nipple-areola complex graft of the normally located breasts. The total weight of the breast tissues removed was {{convert|44.8|kg}}.<ref>{{cite journal|last1=Rahman|first1=G. A.|last2=Adigunt|first2=I. A.|last3=Yusuf|first3=I. F.|last4=Bamigbade|first4=D. P.|title=Macromastia and bilateralaxillary breast hypertrophy: a case report|journal=West African Journal of Medicine|pages=250–252|date=1 July 2007|pmid=18399346|volume=26|issue=3|doi=10.4314/wajm.v26i3.28321|doi-access=free}}</ref>
Another extreme case was observed in 2008 in Maria Vittoria Hospital in Turin, Italy, where the amount removed from both breasts was {{cvt|17.2|kg}}. The growth occurred during puberty making it a case of juvenile gigantomastia, but the patient did not seek treatment until the age of 29.<ref>{{cite journal |doi=10.1016/j.bjps.2008.03.067 |title=A 38 kg skin-reducing bilateral mastectomy: A unique case |year=2009 |last1=Borsetti |first1=G. |last2=Merlino |first2=G. |last3=Bergamin |first3=F. |last4=Cerato |first4=C. |last5=Boltri |first5=M. |last6=Borsetti |first6=M. |journal=Journal of Plastic, Reconstructive & Aesthetic Surgery |volume=62 |issue=1 |pages=133–134|pmid=18694661 }}</ref> Another extreme case was observed on August 28, 2003, when a 24-year-old woman was admitted to the Clinical Center Skopje in North Macedonia with gigantomastia of pregnancy and the amount later removed from both breasts was {{cvt|15|kg}} in total.<ref name="Macedonia">{{cite journal |doi=10.1007/s00404-010-1714-8 |title=Extreme gigantomastia in pregnancy: Case report—my experience with two cases in last 5 years |year=2010 |last1=Antevski |first1=Borce |last2=Jovkovski |first2=Oliver |last3=Filipovski |first3=Vanja |last4=Banev |first4=Saso |journal=Archives of Gynecology and Obstetrics |volume=284 |issue=3 |pages=575–8 |pmid=20978777|s2cid=20169309 }}</ref><ref name="austria">{{cite web|url=http://www.austriantimes.at/index.php?id=8977|title=Macedonia faces 'giant' breast problem|archive-url=https://web.archive.org/web/20120803055350/http://www.austriantimes.at/index.php?id=8977 |archive-date=August 3, 2012}}</ref> A second case in North Macedonia was reported when the breasts of a 30-year-old woman from a remote mountain village in eastern North Macedonia suddenly grew to more than {{convert|30|kg}} total.<ref name="austria"/>
As the disorder becomes more widely known, media reports have increased. French Canadian Isabelle Lanthier appeared{{when|date=June 2022}} on Montel Williams' talk show where she told how her chest grew from {{cvt|86|cm}} to {{cvt|133|cm}} in five months during her pregnancy. At their largest, one breast weighed {{cvt|6.8|kg}} and the other {{cvt|5.4|kg}}. Her husband custom-made a special bra to support her breasts.{{cn|date=June 2022}}
In 2007, a Chilean TV station covered the story of 32-year-old Yasna Galleguillos from Antofagasta, who experienced ongoing back pain, making everyday tasks very difficult to perform. She underwent breast reduction surgery to relieve her pain. Surgeons removed {{convert|4.25|kg}} from one breast and {{convert|3.33|kg}} from the other breast.<ref>{{cite news|url=https://www.mercurioantofagasta.cl/prontus4_noticias/site/artic/20071114/pags/20071114000519.html|title=Jasna Galleguillos|year=2007|publisher=El Mercurio de Antofagasta|language=es}}</ref>
On October 29, 2009, the Philippine television network GMA News and Public Affairs, producers of {{lang|fil|Wish Ko Lang}} ("Just My Wish") hosted by Vicky Morales, profiled the story of Pilma Cabrijas, a 30-year-old woman affected by gigantomastia. The woman was told by a folk healer that her condition may have been caused by a curse. The measured bust circumference without appropriate bra support was {{cvt|160|cm}}. The weight of her breasts was not reported in detail, but seemed to weigh "as much as two children." She had breast reduction surgery performed, but her breasts regrew. The producers of {{lang|fil|Wish Ko Lang}} paid for additional surgery.<ref>{{cite news|url=http://www.gmanews.tv/story/175871/pilma39s-heavy-burden |title=Pilma's heavy burden |date= October 29, 2009|access-date=22 March 2010}}</ref>
====Juvenile breast hypertrophy==== In 1993, the Japanese journal ''Surgery Today'' reported on the case of a 12-year-old girl. Only {{convert|152|cm}} tall and weighing {{convert|43|kg}}, her breasts began to develop at age 11 before the onset of menstruation. Over the next eight months, both breasts grew abnormally large, and physicians treating her found that her physiological development was normal except for her breasts. The weight produced by their symmetrical and massive enlargement resulted in marked curvature of the spine. Lab tests of her blood for hormones and biochemical substances showed normal values, though tests revealed that it might have been caused by hypersensitivity to estrogen. She underwent a bilateral reduction mammoplasty. Surgeons removed {{convert|2|kg}} of tissue from her right breast and {{convert|1.9|kg}} from her left breast. She was administered tamoxifen afterward to suppress breast regrowth.<ref name=morimoto>{{cite journal |doi=10.1007/BF00309238 |title=Juvenile gigantomastia: Report of a case |year=1993 |last1=Morimoto |first1=Tadaoki |last2=Komaki |first2=Kansei |last3=Mori |first3=Toshiaki |last4=Sasa |first4=Mitsunori |last5=Miki |first5=Hitoshi |last6=Inoue |first6=Hiroyuki |last7=Monden |first7=Yasumasa |last8=Nakanishi |first8=Hideki |journal=Surgery Today |volume=23 |issue=3 |pages=260–4 |pmid=8467179|s2cid=37288399 }}</ref>
A more severe case of juvenile breast hypertrophy of an 11-year-old girl was reported in 2008. The breasts had begun to grow rapidly at puberty and had reached the point of causing physical and psychological impairment and possible respiratory compromise after ten months. The skin was intact without any ulcerations. Blood chemistry and endocrine investigation was normal. A bilateral reduction mammaplasty with free nipple grafts was performed. {{cvt|6|kg}} of the right breast and {{cvt|6.5|kg}} of the left breast were removed, resulting in a removal of {{cvt|12.5|kg}} of tissue in all (24% of the total body weight).<ref name=fiumara>{{cite journal |doi=10.1016/j.bjps.2007.10.053 |title=Massive bilateral breast reduction in an 11-year-old girl: 24% ablation of body weight |year=2009 |last1=Fiumara |first1=Linda |last2=Gault |first2=David T. |last3=Nel |first3=Mark R. |last4=Lucas |first4=Dominique N. |last5=Courtauld |first5=Elizabeth |journal=Journal of Plastic, Reconstructive & Aesthetic Surgery |volume=62 |issue=8 |pages=e263-6|pmid=18291739 }}</ref>
==See also== * {{Annotated link|Mammoplasia}} * {{Annotated link|Norma Stitz}}
==References== {{Reflist}}
==Further reading== * {{cite journal |doi=10.1210/jc.2005-0642 |title=Breast Inflammatory Gigantomastia in a Context of Immune-Mediated Diseases |year=2005 |last1=Touraine |first1=P. |journal=Journal of Clinical Endocrinology & Metabolism |volume=90 |issue=9 |pages=5287–5294|pmid=15972574 |doi-access=free }} * {{cite journal |year=2007 |last1=Oladele |first1=AO |last2=Olabanji |first2=JK |last3=Alabi |first3=GH |title=Reduction mammoplasty: The experience in Ile-Ife, Nigeria |volume=16 |issue=3 |pages=261–267 |pmid=17937167 |journal=Nigerian Journal of Medicine }} * {{cite journal |doi=10.1097/00007611-199604000-00019 |title=Massive Asymmetric Virginal Breast Hypertrophy |year=1996 |last1=Netscher |first1=David T. |last2=Mosharrafa |first2=ALI M. |last3=Laucirica |first3=Rodolfo |journal=Southern Medical Journal |volume=89 |issue=4 |pages=434–7 |pmid=8614890}} * [https://www.loc.gov/catdir/samples/wiley031/00066252.pdf U.S.A. Library of Congress - Healthy Breasts: A Primer] * {{cite book |title=The Breast: Its Anomalies, Its Diseases, and Their Treatment |author=John Blair Deaver |author-link=John Blair Deaver |year=1917 |publisher=P. Blakiston's Son & Co |url=https://archive.org/details/breastitsanomal00hermgoog|page=[https://archive.org/details/breastitsanomal00hermgoog/page/n104 102] }} * {{cite book |author=Joseph, Jacques |title=Rhinoplasty and facial plastic surgery with a supplement on mammaplasty and other operations in the field of plastic surgery of the body: an atlas and textbook |publisher=Columella Press |location=Phoenix |year=1987 |page=755 |isbn=0-9605972-1-2 |url=https://books.google.com/books?id=sgzA3opK1D8C&q=hypertrophy+of+the+breast&pg=PA753}} * {{cite journal |doi=10.1097/00000658-192701000-00008 |title=Massive Hypertrophy of the Breasts |year=1927 |last1=Plummer |first1=Samuel C. |last2=Bump |first2=Warner S. |journal=Annals of Surgery |volume=85 |pages=61–6 |pmid=17865606 |issue=1 |pmc=1399262 }} * {{cite book|last=Warren|first=John Collins|title=The International text-book of surgery|url=https://books.google.com/books?id=6MPso2LRx20C&pg=PA234|volume=II|year=1900|publisher=Saunders|page=234}} * {{cite book|last=Erichsen|first=John Eric|title=The Science and art of surgery|url=https://books.google.com/books?id=xzBwgYe0yC8C&pg=PA693|volume=II|year=1885|publisher=H. C. Lea's Son & Company|pages=693–694}} * {{cite book|last=Ochsner|first=Albert John|title=Surgical Diagnosis and Treatment: By American Authors|url=https://archive.org/details/surgicaldiagnos02ochsgoog|year=1921|publisher=Lea & Febiger|page=[https://archive.org/details/surgicaldiagnos02ochsgoog/page/n150 147]}}
== External links == * {{commons category-inline}} {{Medical resources | DiseasesDB = 1628 | ICD10 = {{ICD10|N|62||n|60}} | ICD9 = {{ICD9|611.1}} | ICDO = }} {{Diseases of the breast}}
Category:Breast diseases Category:Rare diseases