Virginal gigantomastia: validity of combined surgical and hormonal treatments

Genetic Factors of Idiopathic Gigantomastia: Clinical Implications of Aromatase and Progesterone Receptor Polymorphisms

The role of estrogen, progesterone, their receptors and aromatase in the development of the breast is well documented. In this study we examined the association of genetic variants of progesterone receptor (PGR) and aromatase (CYP19A1) genes with gigantomastia risk. We conducted a case-control study among 124 women: 60 with gigantomastia and 64 controls. We examined the single nucleotide polymorphisms (SNPs) for CYP19A1 (rs749292 and rs7172156) and PGR (rs1042838). Our results showed that allele G in rs749292 (CYP19A1) increased the risk of gigantomastia, but not significantly (p = 0.09). There is a correlation between rs1042838 (PGR) and waist-to-hip ratio (WHR) in women with gigantomastia-AC genotype correlates with lower WHR and CC with higher WHR. There were no correlations between the onset of gigantomastia, the age of menarche and the length of the menstrual cycle, and rs1042838, rs749292 and rs7172156. We did not find differences in the SNP of PGR (rs1042838) between women with gigantomastia and controls. However, our findings showed more frequent G allele in CYP19A1 (rs749292) in women with gigantomastia.

Body size measurements, digit ratio (2D:4D) and oestrogen and progesterone receptors' expressions in juvenile gigantomastia

Background Juvenile breast hypertrophy is characterised by massive enlargement of the breast in the peri-pubertal period. We aimed to analyse body size measurements (body mass index [BMI], waist-to-hip circumference ratio [WHR]), digit ratio (ratio of II and IV digits' length [2D:4D]) and oestrogen receptor (ER) alpha (ERα) and progesterone receptors (PRs) in the breast gland in women with juvenile gigantomastia. Methods The study involved 30 women (mean age 25.7 years) (mean age of onset - 14.8 years). ERα and PR expressions were detected immunohistochemically in breast gland samples. For comparison, 100 controls (50 women and 50 men) were included. Results BMI and WHR in women with gigantomastia were higher than in control women and the former had a higher WHR than expected for their BMI. 2D:4D in the examined women did not differ from that in control women. However, left 2D:4D was negatively related to the age of gigantomastia onset. There were no correlations between ER and PR expressions and the analysed body and digit ratios. Conclusions The lack of a relationship between 2D:4D and juvenile breast hypertrophy may suggest that foetal exposure to sex hormones may not be crucial in its aetiology. However, the link between high left 2D:4D and early development of gigantomastia suggests that prenatal sex hormones have a role in its development timing. High WHR, and particularly high WHR relative to BMI, may indicate that these women had at some stage of development higher circulating androgens, which may have been converted to oestrogens in breasts due to local aromatase activity. Verification of this hypothesis could allow consideration of the role of aromatase inhibitors in juvenile breast hypertrophy.

Prednisolone-induced virginal mammary hypertrophy: Case report

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Virginal Mammary Hypertrophy is a rare condition.

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Virginal Mammary Hypertrophy can be physically and psychologically debilitating.

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A 17-year old with breast hypertrophy following prednisolone treatment is discussed.

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The patient was treated with a bilateral mammaplasty following appropriate counseling.

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Four years after the original procedure, there was no recurrence of hypertrophy.

Introduction

Virginal mammary hypertrophy (VMH) is a rare benign disorder of the breast characterized by excessive enlargement of one or both breasts. It usually presents during adolescence. Drug-induced VMH has been scarcely reported in case reports. Review of the literature showed that prednisolone-induced gigantomastia was reported in a single study on a 47-year-old female. In this study, a case of VMH in a 17-year-old girl following prednisolone treatment will be described. Clinical presentation, clinical findings, diagnostic work-up, management and follow up are discussed.

Presentation of case

A 17-year-old, single female presented to the plastic surgery department at our institute with progressive enlargement of both breasts, 2 months following treatment with prednisolone. Incisional biopsy excluded other breast differential diagnoses. The patient was managed surgically with bilateral mammaplasty with free nipple-areola graft. A total of 8.325 kg of breast tissue was resected. Follow-up 48 months postoperatively revealed good patient satisfaction with no recurrence of breast hypertrophy.

Discussion

Although the estrogen theory is regarded as the most credible explanation for VMH, several cases of drug-induced mammary hypertrophy have been reported. This study may be the first reported case of adolescent prednisolone-induced VMH. Mammaplasty is an accepted treatment despite its possible association with a higher recurrence rate.

Conclusion

VMH may be a rare complication of prednisolone treatment. It should be considered in patients presenting with breast hypertrophy following steroid administration.

Virginal breast hypertrophy in a patient with Beckwith-Wiedemann syndrome

Virginal breast hypertrophy is a multidisciplinary condition including surgical, pediatric, and endocrine/gynecological disciplines, and its successful diagnosis and management requires complex, team approach.

Gigantomastia and Macroprolactinemia Responding to Cabergoline Treatment: A Case Report and Minireview of the Literature

Background. Macroprolactinemia is defined as predominance of high molecular weight prolactin forms in the circulation. Although macroprolactin is considered as a biologically inactive molecule, some authorities suggest treatment in symptomatic cases. Gigantomastia is defined as excess breast tissue and most cases in the literature were treated by surgical intervention. Case. A 44-year-old woman was admitted to our clinic with gigantomastia and galactorrhea. The patient had a demand for surgical therapy. In laboratory examination, she had hyperprolactinemia and macroprolactinemia. Pituitary imaging revealed 6 mm microadenoma in right side of the hypophysis. Since she was symptomatic, cabergolin treatment was started. Macroprolactin became negative, breast circumference decreased significantly, and galactorrhea resolved after treatment. Conclusion. Gigantomastia might be the presenting symptom in patients with macroprolactinemia. In these patients medical treatment with cabergoline may be used initially as an alternative to surgical approach.

[Gigantomastia: report of a case and review of the literature]

L'hypertrophie virginale ou gigantomastie est une mastopathie rare de cause inconnue. Elle survient au moment de la puberté et se manifeste cliniquement par un accroissement rapide et bilatéral du volume des seins. Les dosages hormonaux sont habituellement normaux et la biopsie du sein montre une accentuation du tissu mésenchymateux. Du fait des complications mécaniques et psychologiques liées aux poids et volume excessifs des seins, un traitement chirurgical rapide et efficace s'impose. Le But est de rapporter un cas rare de gigantomastie juvénile, discuter les éventualités thérapeutiques ainsi que le pronostic.

Hyperplastic breast anomalies in the female adolescent breast

Macromastia in adolescents is multifactorial and usually idiopathic, associated with obesity or hormonal imbalances. Less commonly, it can result from virginal or juvenile breast hypertrophy, a rare condition of unknown etiology, where an alarmingly rapid breast enlargement occurs during puberty. Breast hypertrophy in the adolescent population can have significant long-term medical and psychological impacts. Although symptoms can be severe, many plastic surgeons, pediatricians, and parents are often reluctant to surgically treat adolescent macromastia. However, reduction mammoplasty is a safe and effective treatment and may be the only way to alleviate the increased social, psychological, and physical strain caused by macromastia in adolescents.

Nonsurgical management of fibroadenoma and virginal breast hypertrophy

The management and treatment of an adolescent presenting with a fibroadenoma or virginal breast hypertrophy can be challenging as there is a paucity of original research on these conditions. Although surgical therapies are often discussed as first-line therapy in adolescents presenting with a breast mass, it is prudent that nonsurgical interventions and medical therapies be considered as initial therapy with the goal of maintaining an acceptable cosmetic outcome.

Breast reduction in adolescents: indication, timing, and a review of the literature

BACKGROUND

Adolescent breast hypertrophy can have long-term negative medical and psychological impacts. In select patients, breast reduction surgery is the best treatment. Unfortunately, many in the general and medical communities hold certain misconceptions regarding the indications and timing of this procedure. Several etiologies of adolescent breast hypertrophy, including juvenile gigantomastia, adolescent macromastia, and obesity-related breast hypertrophy, complicate the issue. It is our hope that this paper will clarify these misconceptions through a combined retrospective and literature review.

METHODS

A retrospective review was conducted looking at adolescent females (≤18 years old) who had undergone bilateral breast reduction surgery. Their preoperative comorbidities, BMI, reduction volume, postoperative complications, and subjective satisfaction were recorded. In addition, a literature review was completed.

RESULTS

34 patients underwent bilateral breast reduction surgery. The average BMI was 29.5 kg/m(2). The average volume resected during bilateral breast reductions was 1820.9 g. Postoperative complications include dehiscence (9%), infection (3%), and poor scarring (6%). There were no cases of recurrence or need for repeat operation. Self-reported patient satisfaction was 97%. All patients described significant improvements in self body-image and participation in social activities. The literature review yielded 25 relevant reported articles, 24 of which are case studies.

CONCLUSION

Reduction mammaplasty is safe and effective. It is the preferred treatment method for breast hypertrophy in the adolescent female and may be the only way to alleviate the increased social, psychological, and physical strain caused by this condition.

Virginal mammary hypertrophy: a meta-analysis and treatment algorithm

BACKGROUND

Virginal mammary hypertrophy, a rapid enlargement of one or both breasts that usually presents in the adolescent years, is a rare condition that has been reported sporadically in the medical literature. Currently, there are no patient- or disease-oriented evidence-based guidelines for the treatment of this condition. This meta-analysis examines the published case reports and presents a cumulative algorithm for the diagnosis and treatment of this uncommon condition.

METHODS

A literature search was performed using PubMed, with multiple keywords. Information regarding patient age, menarchal state, mass of excision, surgical technique, number of operations, pharmacologic intervention, and recurrence was extracted from each case report and analyzed using SPSS 15.1 statistical software.

RESULTS

A significant relationship was found (p < 0.01), as was an odds ratio of 7.0, for the likelihood of recurrence using a reduction mammaplasty as opposed to a mastectomy.

CONCLUSIONS

Based on the evidence presented in this article, certain interventions are more effective for the treatment of virginal mammary hypertrophy. On diagnosis of virginal mammary hypertrophy, tamoxifen therapy may be considered based on previous literature, barring any medical contraindications. A subcutaneous mastectomy with complete removal of breast tissue is the procedure least likely to lead to recurrence but is more deforming. Reduction mammaplasty gives an improved aesthetic breast, but it is important to counsel the patient on the likelihood of increased recurrence. Tamoxifen therapy following surgery may decrease the recurrence rate.

Massive bilateral breast reduction in an 11-year-old girl: 24% ablation of body weight

An 11-year-old girl with massive virginal breast hypertrophy is presented. The breasts had begun to grow rapidly at puberty and had reached an enormous size within a year, to the point of causing physical impairment and respiratory compromise. Routine blood chemistry and endocrine investigation was normal, as was an MRI scan of the pituitary fossa. A bilateral reduction mammaplasty with free nipple grafts was performed, removing 12.5 kg of tissue in all (24% of the total body weight). There was no recurrence at a 2 year follow up, and no requirement for additional surgery. A review of the literature reveals that breast regrowth is less frequent when free nipple grafting is used, and this technique is recommended for these extraordinary cases.

Bilaterally symmetric juvenile fibroadenomas and tubular breast deformity in a prepubescent girl

Juvenile fibroadenomas are rare and usually not associated with other disease processes. We report the first known case of bilateral juvenile fibroadenomas in conjunction with tubular breast deformity in a prepubescent girl.

[Relapse of gigantomastia after mammoplasty. Report of a case and literature review]

Gigantomastia is a very rare entity of undetermined aetiology that may be due to hormonal imbalance, decreased hormonal catabolism or hypersensitivity of the target organ. It poses the problem of surgical treatment, which can be exceptionally radical of necessity. We report a case of a 32-year-old woman of whom volume and vasculocutaneous complications required a simple bilateral mastectomy to treat a recurrence of gigantomastia occurring some months after a mammoplasty. Most of the cases of gigantomastia found in the literature are associated to the pregnancy or puberty and very rare cases of spontaneous gigantomastia were listed.

Gigantomastia unrelated to pregnancy or puberty: a case report

Idiopathic gigantomastia occurs during puberty and pregnancy but a spontaneous case has not been reported in the literature. An unusual case is described, which required urgent bilateral mastectomy to control systemic sepsis and extreme discomfort.

Failure of bromocriptine therapy to control juvenile mammary hypertrophy

Rapid massive breast hypertrophy occasionally occurs at the time of puberty or during pregnancy, with breast size eventually becoming burdensome or incapacitating to the patient. Pregnancy-related breast hypertrophy is often arrested or reversed by reducing serum prolactin levels with bromocriptine therapy. Unfortunately, breast enlargement in our 12-year-old patient with massive juvenile mammary hypertrophy was unaffected by bromocriptine therapy despite a reduction of her prolactin to normal levels. Two reduction mammaplasties followed by subcutaneous mastectomy were required to control breast hypertrophy. Breast-tissue hypersensitivity to prolactin appears to be a characteristic of pregnancy-related gigantomastia. Our pubertal patient with juvenile mammary hypertrophy failed to respond to bromocriptine therapy, so the aetiology of this syndrome may involve breast-tissue hypersensitivity to hormones other than prolactin.