Gestational gigantomastia accompained by distal breast tissue necrosis. A case report
https://doi.org/10.14341/serg10306
Abstract
Rare condition characterized by an intensive and excessive breast enlargement is known as gigantomastia. Gestational gigantomastia manifests during pregnancy and could represent a life-threatening condition for both the mother and the fetus, therefore the risk of spontaneous abortion complicates the choice of treatment approach. We present a clinical case of a patient requesting medical assistance with a progressive breast growth. The onset occurred on the 5th week of gestation and, subsequently, was aggravated by distal tissue necrosis. The ambiguity of treatment approach in such situation is based on, on the one hand, the insecurity of watch-and-wait approach due to the high risk of septic complications and, on the other hand, the increasing danger of fetal loss in the case of surgical treatment during the first trimester of pregnancy. After an adequate assessment of mother’s health state, a decision was made towards the wait-and-see tactic until the complete formation of the placental barrier. A total bilateral mastectomy was performed at the 19th week of pregnancy, with a favorable outcome for the patient and her child. This case emphasizes the significance of an individual, interdisciplinary approach to the choice of management for patients with this pathology.
About the Authors
Anastassia ChevaisRussian Federation
medical resident
Andrey L. Ischenko
Russian Federation
MD, PhD
Dmitriy G. Beltsevich
Russian Federation
MD, ScD, Professor, leading research associate of the surgery department
Valeriy V. Voskoboynikov
Russian Federation
MD, PhD
Valeriy N. Kurdyukov
Russian Federation
MD
Elena V. Pokrovskaya
Russian Federation
clinical resident
References
1. Dafydd H, Roehl KR, Phillips LG, et al. Redefining gigantomastia. J Plast Reconstr Aesthet Surg. 2011;64(2):160-163. doi: https://doi.org/10.1016/j.bjps.2010.04.043.
2. Mojallal A, Moutran M, Martin E, Braye F. Gigantomastia – a classification and review of the literature. J Plast Reconstr Aesthet Surg. 2009;62(2):262-263. doi: https://doi.org/10.1016/j.bjps.2008.07.014.
3. Bland KI, Copeland EM, Klimberg VS, Gradishar WJ, editors. The breast: comprehensive management of benign and malignant diseases. 5th ed. Elsevier Inc; 2018. pp. 92-178. doi: https://doi.org/10.1016/C2014-0-01946-6.
4. Gayon-Vera E. Danazol as an effective treatment in a premenarchal girl with juvenile breast hypertrophy. Research. 2014;1:755. doi: https://doi.org/10.13070/rs.en.1.755.
5. Тютюнник В.Л., Шифман Е.М., Параконная А.А., Балушкина А.А. Макромастия, манифестировавшая при беременности. Клинические наблюдения с двусторонней мастэктомией и благоприятным исходом // Акушерство и гинекология. – 2012. – №6. – C. 81-84. [Tyutyunnik VL, Shifman EM, Parakonnaya AA, Balushkina AA. Macromastia of pregnancy: clinical cases of bilateral mastectomy and a good outcome. Akush Ginekol (Mosk). 2012;(6):81-84. (In Russ.)]
6. Shimatsu A, Hattori N. Macroprolactinemia: diagnostic, clinical, and pathogenic significance. Clin Dev Immunol. 2012; 2012:167132. doi: https://doi.org/10.1155/2012/167132.
7. Dancey A, Khan M, Dawson J, Peart F. Gigantomastia – a classification and review of the literature. J Plast Reconstr Aesthet Surg. 2008;61(5):493-502. doi: https://doi.org/10.1016/j.bjps.2007.10.041.
8. Swelstad MR, Swelstad BB, Rao VK, Gutowski KA. Management of gestational gigantomastia. Plast Reconstr Surg. 2006;118(4):840-848. doi: https://doi.org/10.1097/01.prs.0000232364.40958.47.
9. Antevski BM, Smilevski DA, Stojovski MZ, et al. Extreme gigantomastia in pregnancy: case report and review of literature. Arch Gynecol Obstet. 2007;275(2):149-153. doi: https://doi.org/10.1007/s00404-006-0190-7.
10. Le EN, McGrit LY, Abuav R. Gigantomastia and autoimmunity: a case report. Lupus. 2009;18(11):1015-1018. doi: https://doi.org/10.1177/0961203309105362.
11. Govrin-Yehudain J, Kogan L, Cohen HI, Falik-Zaccai TC. Familial juvenile hypertrophy of the breast. J Adolesc Health. 2004;35(2):151-155. doi: https://doi.org/10.1016/j.jadohealth.2003.09.017.
12. Lanzon A, Navarra S. Gigantomastia in a patient with systemic lupus erythematosus successfully treated by reduction mammoplasty. Lupus. 2009;18(14):1309-1312. doi: https://doi.org/10.1177/0961203309106690.
13. Щербакова Н.И., Хрущева Н.А., Антонова К.В., и др. Сочетание миастении и гигантомастии: тесное переплетение аутоиммунных гормональных и паранеопластических факторов // Неврологический журнал. – 2017. – T.22. – №1. – C. 25-32. [Shcherbakova NI, Khrushcheva NA, Antonova KV, et al. The association of autoimmune, hormonal and paraneoplastic factors in myasthenia with gigantomastia. Nevrologicheskii zhurnal/Journal of neurology. 2017;22(1): 25-32. (In Russ.)] doi: https://doi.org/10.18821/1560-9545-2017-22-1-25-32.
14. Воскобойников В.В., Ищенко А.Л., Фирсов А.В., и др. Сочетание макромастии и миастении. Клиническое наблюдение // Эндокринная хирургия. – 2014. – T.8. – №3. – C. 35-38. [Voskoboinikov VV, Ishchenko AL, Firsov AV, et al. The combination of macromastia and myasthenia gravis. Clinical observation. Endocrine surgery. 2014;8(3):35-38. (In Russ.)] doi: https://doi.org/10.14341/serg2014335-38.
15. Zingaretti N, De Biasio F, Riccio M, et al. A case of gestational gigantomastia in a 37-years-old woman associated with elevated ANA: a casual linkage? Pan Afr Med J. 2017; 27:167. doi: https://doi.org/10.11604/pamj.2017.27.167.11281.
16. Rezai S, Nakagawa JT, Tedesco J, et al. Gestational gigantomastia complicating pregnancy: a case report and review of the literature. Сase Rep Obstet Gynecol. 2015;2015:892369. doi: https://doi.org/10.1155/2015/892369.
17. Dellal FD, Ozdemir D, Aydin C, et al. Gigantomastia and macroprolactinemia responding to cabergoline treatment: a case report and minireview of the literature. Case Rep Endocrinol. 2016;2016:3576024. doi: https://doi.org/10.1155/2016/3576024.
18. Demir K, Unuvar T, Eren S, et al. Tamoxifen as first-line treatment in a premenarchal girl with juvenile breast hypertrophy. J Pediatr Adolesc Gynecol. 2010;23(5):e133-136. doi: https://doi.org/10.1016/j.jpag.2009.11.003.
19. Sridhar GR, Sinha MJ. Macromastia in adolescent girls. Indian Pediatr. 1995;32(4):496-499.
20. Chargui R, Houimli S, Damak T, et al. [Relapse of gigantomastia after mammoplasty. Report of a case and literature review. (In French).] Ann Chir. 2005;130(3):181-185. doi: https://doi.org/10.1016/j.anchir.2004.12.007.
21. Benna M, Naser RB, Fertani Y, et al. Extreme idiopathic gigantomastia. Int J Res Med Sci. 2018;6(5):1808-1811. doi: https://doi.org/10.18203/2320-6012.ijrms20181782.
22. Boufettal H, Khalkane L, Dlia H, et al. [Bilateral gestational macromastia: about one case. (In French).] Imagerie de la femme. 2013;23(1):32-35. doi: https://doi.org/10.1016/j.femme.2013.02.003.
Supplementary files
|
1. Fig. 1. Mammography of 2017 after subtotal reduction plastic surgery with prosthetics. | |
Subject | ||
Type | Other | |
View
(20KB)
|
Indexing metadata ▾ |
|
2. Fig. 2. Gigantomastia at the 18th week of pregnancy. View in full view. | |
Subject | ||
Type | Other | |
View
(34KB)
|
Indexing metadata ▾ |
|
3. Fig. 3. Gigantomastia at the 18th week of pregnancy. Profile view. | |
Subject | ||
Type | Other | |
View
(38KB)
|
Indexing metadata ▾ |
|
4. Fig. 4. Expansion of superficial veins with signs of thrombosis. | |
Subject | ||
Type | Other | |
View
(48KB)
|
Indexing metadata ▾ |
Review
For citations:
Chevais A., Ischenko A.L., Beltsevich D.G., Voskoboynikov V.V., Kurdyukov V.N., Pokrovskaya E.V. Gestational gigantomastia accompained by distal breast tissue necrosis. A case report. Endocrine Surgery. 2019;13(3):141-147. (In Russ.) https://doi.org/10.14341/serg10306

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND 4.0).