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Gestational gigantomastia with massively haemorrhagic ulcers
  1. Srinjoy Saha
  1. Dept. of Plastic Surgery, Apollo Gleneagles Hospital, Kolkata, West Bengal, India
  1. Correspondence to Dr Srinjoy Saha, Dept. of Plastic Surgery, Apollo Gleneagles Hospital, Kolkata, WB 700054, India; ss{at}medi.ac

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A 26-year-old newlywed woman attended our clinic with gigantic breasts associated with neck and back pain, and severe bleeding from breast ulcers. Her breasts had enlarged rapidly within the first 2 months of her first pregnancy, causing approximately 25 kg of weight gain and later, swelling over both the lower limbs. Medical therapy was instituted, but failed to halt breast tissue growth or relieve symptoms. Ultimately, she underwent an abortion at the end of the first trimester of pregnancy, which finally stopped breast enlargement. However, bleeding breast ulcers were problematic. Once, profuse bleeding caused haemorrhagic shock, necessitating multiple blood transfusions.

Examination revealed anaemia, enlarged axillary nodes and engorged subcutaneous veins. Breast tissues were visibly reddish, firm and non-tender on palpation. Sternal notch-to-nipple distances were 62 cm (right) and 60 cm (left), inframammary fold-to-nipple distances were 42 cm (left) and 40 cm (right), with areolar diameters 21 cm bilaterally (figure 1). Multiple ulcerations with granulating bases were present, with the largest sized 8×7 cm near the left areola (figure 2). High-frequency ultrasonography revealed several highly vascularised lactating adenomas, nodular hyperplasia and fibroadenomas, with the largest sized 8×2.4×7.4 cm. Histopathology from all adenoma and node biopsies were benign. Excepting low haematocrit, biochemical parameters and hormone levels were normal. She preferred to avoid early surgery and wait-and-watch for spontaneous breast-size regression.

Figure 1

Frontal view of a newlywed primipara in her late 20’s with huge gigantomastia persisting after abortion. Dilated engorged veins are visible on the breast and upper chest. Ulcerations with a granulating base are visible near the left areola.

Figure 2

Oblique and Lateral views from the right and left sides in the same patient. Once, profuse bleeding from the breast ulcers led to haemorrhagic shock, necessitating intensive care management.

Gestational gigantomastia is rare and incapacitating, characterised by rapid and disproportionate breast enlargement during pregnancy causing >3% of total body weight.1 Caused by hormonal stimulation,2 it sometimes regresses after delivery/abortion, but recurs during subsequent pregnancies.3 Ultimately, it benefits from total mastectomy and breast reconstruction.4

Ethics statements

Patient consent for publication

Ethics approval

This report was conducted according to the principles of the Declaration of Helsinki. As this is a case report without identifiers, our institution does not require approval from the Institutional Review Board or its equivalent.

Acknowledgments

The author acknowledges Dr Suma Chakrabarthi, MBBS, MD.

References

Footnotes

  • Twitter @srinjoysaha

  • Correction notice This article has been corrected since it first published. The provenance and peer review statement has been included.

  • Contributors SS was the patient’s consultant, performed the reported clinical examination, prepared the submitted images and composed the submitted manuscript entirely.

  • Funding The author has not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.