Gigantomastia cause, symptoms and treatment
Gigantomastia is one of the rare medical conditions where breast get extremely enlarged. You can see the drooping breast with nipples and areolas hanging down. Breast is a not only an organ but an asset of self-esteem that boosts the physical appearance of a woman. Gigantic breast can give poor look to women and hamper rheir quality of life.
Huge breast can cause you pain and discomfort on your neck, back and chest area. Furthermore, it can cause infection and adversely affect your posture as well.
What is Gigantomastia?
Gigantomastia is derived from two greek words gigantikos and mastos. gigantikos refers to giant, whereas mastos refers to breast. It means the unusual extreme large size of the breast.
Gigantomastia is also referred to as Macromastia. However, there is a small difference in their severity.
If the size of the breast ranges between 1-5 kilograms to 2.5 kilograms, we call it macromastia. We call it Gigantomastia if the size is beyond 2.5 kilograms.
There are two kinds of breast tissue growth such as:
- Unilateral: exponential growth of breast tissue in a single organ
- Bilateral: it affects both the organ
In this case, the connective tissues elongate causing hypertrophy of the breast. It takes years for women to have a full grown breast. But, the size increases rapidly within few days in women with gigantomastia.
Macromastia usually does not have any symptom. There is no specific symptom and different kinds of the disease show different symptoms. One of the common symptoms is the difference in size of the breast.
The symptoms of gigantomastia are the following;
- Pain and discomfort on your neck, back, and chest area.
- It can cause infection
- Adversely affect your posture.
- Ulceration due to over stretching of the breast and areolas.
- Huge breasts
- Desensitized nipples
- Mastalgia (Pain in the breast)
- Extreme gigantomastia can cause you breathing issues.
There is no known cause of gigantomastia till date. You can find this abnormality in few hundreds of women worldwide. But this condition is never found in men.
Genetics can be a contributing factor for hypertrophy of the breast. If your mother had macromastia or enlarged breast, you can have this condition as well.
Studies suggest that genetic mutation in PTEN gene is responsible for causing macromastia. PTEN gene is a gene that is responsible for producing a kind of enzyme that suppress tumor cells.
Female sex hormones:
There we speculation that a higher level of female sex hormones during puberty might be the cause.
However, further studies refuted this assumption.
It was found that breast hypertrophy can also occur in females with normal blood levels of female sex hormones. Still, juvenile gigantomastia is caused due to hypersentisitivity to some female sex homones such as oestrogen, progesterone, prolactin, gonadotropin etc.
Others factors causing gigantomastia:
Excess release or hypersensitivity of growth hormones can also trigger extreme breast growth. The known growth hormones include the following.
- Epidermal growth factor
- Insulin-like growth factor 1
- Hepatic growth factor
It was found that high body weight females are prone to develop this condition. The female breast is usually composed of adipose tissue, fibrous tissue, and glandular tissue. Adipose and fibrous tissue tends to grow faster in breast hypertrophy whereas glandular issue do not grow.
Gigantomastia is associated with consumption of some medications such as:
The contributing factors may also include some autoimmune diseases such as psoriasis, systemic lupus erythematosus, myasthenia gravis, arthritis, and Hashimoto’s thyroiditis.
There are a few other reasons noted till that causes gigantomastia in some female individuals. The reasons are as follows:
- Aromatase excess syndrome (An excess secretion of estrogen, also known as hyperestrogenism occurs in this medical condition)
- Hypercalcemia: If the concentration of parathyroid hormone-related protein is higher in your blood, you may suffer from breast hypertrophy.
- Hyperprolactinemia: An excess blood concentration of prolactin.
- Pseudoangiomatous stromal hyperplasia
Types of gigantomastia
Gigantomastia is broadly classified into five categories.
- Puberty induced hypertrophy (Also known as virginal hypertrophy of juvenile gigantomastia)
- Gestational gigantomastia ( Also known as pregnancy-induced hypertrophy or gravid macromastia)
- Idiopathic breast hypertrophy (Associated with an unknown reason)
- Drug-Induced breast hypertrophy (Induced by certain medications)
- Obesity-induced hypertrophy (Induced by high-calorie diet).
Puberty induced hypertrophy:
This kind of hypertrophy of the breast usually occurs during onset adolescence or puberty. This condition has several other synonyms, such as
- Juvenile gigantomastia
- Juvenile macromastia
- Virginal breast hypertrophy
- Virginal mammary hypertrophy
There are cases where the breast size enlarges enormously just with the onset of puberty and after the first menstruation. However, in few other instances, it was found that extreme growth of the breast started before the beginning of menstruation.
Slow progression in the size of breast growth was seen in some individuals, which ultimately led to the massive breast size. Few other individuals reported a sudden rise in breast growth in a very small interval of time. In a rare case, enlargement of clitoris and nipples were also found.
Gestational gigantomastia is also referred to as gestational mastitis or gestational breast hypertrophy. This kind of breast hypertrophy usually affects pregnant women.
If your gestation period is between 4 months to 5 months, you are more like to have such kind of gigantomastia. Breast swells after delivery and it can hamper milk production as well.
The breast swells further in the next subsequent pregnancies. Following are the complications a swollen breast can produce.
- Excess heat in the breast area
- A feeling of discomfort and pain
- Inadequate milk supply
- Red, itchy skin
Idiopathic breast hypertrophy:
This is the most common type of gigantomastia found in adolescents. It is idiopathic macromastia because there is no known cause of this kind of breast hypertrophy.
Drug-Induced breast hypertrophy:
There are certain medications such as D-penicillamine and can trigger this kind of gigantomastia. D-penicillamine is drug to treat various illnesses such as cystinuria, Wilson’s disease, and rheumatoid arthritis.
Most of the cases of gigantomastia are found in obese women. Women with excess body weight are more prone to develop breast hypertrophy. Moreover, high-fat diet and high-calorie diet worsen the condition of macromastia. The cause of such hypertrophy may be due to the build-up of adipose tissue in the breast area
We don’t follow a standard treatment regimen for breast hypertrophy. Treatment approach varies with the symptoms and type of gigantomastia. The symptoms such as inflammation, pain, ulcers, and infections are treated with first priority.
Most of the time, gestational gigantomastia does not need treatment and go away once the pregnancy is over. The primary objective of treating macromastia is to reduce the size of the breast. And, to fulfill the objective following medications, surgery, hormonal therapy are recommended.
The primary objective of the medications is to reduce the size of the breast. The doctor may prescribe some medications to alleviate, pain, infection, irritation etc. as well.
Tamoxifen: Tamoxifen is a drug used to treat breast cancer. This medication modulates the estrogen receptors, the receptor on which estrogen binds to show its effects. Therefore, the drug is also known as SERM (selective estrogen receptor modulator).
Danzol: Dangol has poor androgenic properties, however, it is an antiestrogen. This medication is used to treat endometriosis and fibrocystic breast disease symptoms
Medroxyprogesterone: Medroxyprogesterone hormone regulates both ovulation and menstruation in females. This progestin hormone is sometimes prescribed by a doctor to a gigantomastia patient to prevent excess growth of breast tissue. The most common brand prescribed is Depo-Provera.
Bromocriptine: The most common brand name of bromocriptine is Parlodel. This medication is a dopamine receptor agonist. It affects the dopamine receptor, imparts dopamine like function.
Therefore, the physician prescribes this medication to treat Parkinson’s disease, hyperprolactinemia, neuroleptic malignant syndrome, and diabetes. However, you may consume this medication upon doctors approval to treat macromastia patient due to its potential to inhibit breast growth.
Surgery to treat macromastia includes partial or complete removal of breast tissue. Following are the few surgical procedures carried out to inhibit hypertrophy of breast.
Reduction mammoplasty: Reduction mammoplasty is the breast reduction surgery. If you are who are uncomfortable with your enlarged breast or a sufferer of gigantomastia then you can go for this kind of surgical procedure.
You will require a plastic surgeon to do this for you. The plastic surgeon will remove your extra breast tissue, remove skin and reposition the nipples as well.
Preparation of breast reduction surgery:
Before carrying out the surgery, the doctor will communicate and explain the details of the surgery to you.
The surgeon will examine your both breasts. He will measure it, take a photograph and discuss the pros and cons of the surgery as well.
There might be scarring of the breast after surgery, the physician will inform you about this including all other possible complications.
The doctor will recommend you to take a baseline mammogram. Moreover, the doctor will ask you to undergo few other blood tests as well.
Before the surgery ask the doctor if can go home or stay in the hospital for the whole night after surgery.
Surgical removal of breast tissue consists of either liposuction or surgery through an incision.
The surgeon will carry out an incision around the areola and remove out excess breast tissues. Then he will relocate the nipple. This is how the surgery is performed to reduce the size of the breast.
There are few guidelines to adopt before the surgical procedure. The doctor will ask you if you are pregnant. If you are pregnant, the doctor will ask you to wait until the finish of the breastfeeding. Moreover, to prevent any kind of reoccurrence, the doctor may ask you to wait until your puberty.
Once the surgery is complete, you have to visit the doctor once in six months.
Mastectomy and implants:
Mastectomy is the complete removal of breast tissue. Doctor does not prefer this kind of surgery due to involvement of more complications. However, there is less chance of reoccurrence with this surgery.
Once the mastectomy is over, you need an implant of new breast tissues. Sometimes, women who undergo this surgery are not able to breastfeed their child.
Surgery is the most common preferred method to treat gigantomastia. However, reoccurrence may occur in patients with puberty induced macromastia or gestational breast hypertrophy.
Therefore, you must for doctor’s suggestion to confirm the right kind of treatment approach for yourself. A successful surgery will reduce the pain in your upper extremities. However, the shape and size of your breasts may differ after surgery. Further studies are being carried out to manage this condition.