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Hypertrophy of breast

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Gigantomastia
Classification and external resources
Durston, a physician in 1670, drew this image to record the first known case of non-gravid gigantomastia. The patient died as a result of the disease.
ICD-10 N62.
ICD-9 611.1
DiseasesDB 1628

Hypertrophy of breast, gigantomastia or macromastia is a rare connective tissue disorder. It has been qualified as enlargement of the breast exceeding 600 grams (21 oz), causing discomfort and stretching of the overlaying skin leading to ulceration.[1] Also known as macromastia, it is the bilateral, benign progressive enlargement of the human breasts. Gigantomastia was first described in scientific literature in 1648.[2] The condition may be caused by heightened sensitivity to the female hormones prolactin, estrogen and progesterone, and/or the presence of an unusually high quantity of these hormones in the woman's bloodstream. Studies appear to show an abnormal reaction of the breast tissue to hormonal factors.[3] In severe cases, a single breast of women with this disorder can weigh in excess of 20 pounds (9.1 kg) each. The largest recorded weight was 67 pounds (30 kg) per breast. It is most often related to pregnancy, estimated to occur 1 out of every 28,000 to 100,000 pregnancies worldwide.

Contents

General condition

Hypertrophy can affect breasts equally but usually affects one breast more than the other, causing asymmetry, in which one breast becomes substantially 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 (virginal hypertrophy), gestational (gravid macromastia), in adult women without any obvious cause, associated with penicillamine therapy, and associated with extreme obesity.[1] The underlying cause of the rapidly growing breast connective tissue, resulting in gigantic proportions, is thought to be a heightened sensitivity to female hormones prolactin, estrogen and progesterone.

Virginal breast hypertrophy

When Gigantomastia occurs in young women during puberty, the medical condition is known as juvenile macromastia or juvenile gigantomastia and sometimes as Virginal breast hypertrophy. 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 her first menstrual period. Some doctors suggest that breast development occurs before onset of menstruation.[4]

Some women with Virginal breast hypertrophy experience breast growth at a constant rate for several years, but 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 causes great physical discomfort.

At the onset of puberty, some females who have experienced little or no breast development can grow three or more cup sizes within a few days.[5]

Gestational 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.[5] 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.[5]

Medical treatment

Medical treatment has not proven consistently effective. Medical regimens have included tamoxifen,[6] progesterone, bromocriptine, and testosterone. Surgical therapy includes reduction mammaplasty and mastectomy.[7] However, breast reduction is not clinically indicated unless at least 4 pounds (1.8 kg) of tissue per breast needs to be removed.[8] 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.[5]

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. Once a girl's 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.[9]

Medical insurance coverage

Insurance companies 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 reduction mammoplasty. 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.[10] A plastic surgeon in Seattle, Dr. Phil Haeck, told a reporter that most of his breast reduction patients pay their own way. "I’ve had people finance it; I’ve had people get second mortgages, take out home equity loans."[10]

Reported instances

Gigantomastia

A painting by Lam Qua of Lu-shi, age 42, on April 17, 1848, prior to breast reduction surgery.

Gigantomastia occurs in 1 out of every 28,000 to 100,000 pregnancies.[11] It can also affect men, although very rarely. One early case study dates to 1670. The patient died four months after the onset of enlargement. One breast removed after the woman's death weighed 64 pounds (29 kg).[12]

On April 17, 1848, a 42-year-old woman named Lu-shi was treated for hypertrophy in a Chinese hospital. She was treated by Dr. Peter Parker, a missionary physician. On December 24, 1849, the left breast, measuring 2 feet 2.5 inches (0.673 m) in circumference, and weighing 6 pounds (2.7 kg), was removed in a procedure lasting three and a half minutes. The right breast was removed one month later. It measured 2 feet (0.61 m) in circumference and weighed 5.5 pounds (2.5 kg).[13]

In the October 2002 Journal of Reproductive Medicine, Dr. N. Agarwal with three other doctors from the All India Institute of Medical Sciences in New Delhi reported on a 24-year-old woman who was pregnant with her second child. During her 19th week of pregnancy, she experienced a "massive bilateral breast enlargement." She was treated for six months after her child was born before her breasts were reduced to their normal size.[14]

Another extreme case was observed in 2008 in Maria Vittoria Hospital in Turin, Italy, where the amount removed from both breasts was 38 kilograms (84 lb). The growth occurred during puberty making it a case of juvenile gigantomastia, but the patient did not seek treatment until the age of 29.[15] Another extreme case was observed on August 28, 2003 when a 24-year-old woman was admitted to the Clinical Center Skopje in Macedonia with gigantomastia of pregnancy and the amount later removed from both breasts was 33 kilograms (73 lb) total.[16][17] A second case in Macedonia was reported when the breasts of a 30-year-old woman from a remote mountain village in eastern Macedonia suddenly grew to more than 30 kilograms (66 lb) total.[17]

As the disorder becomes more widely known, media reports have increased. French Canadian Isabelle Lanthier appeared on Montel Williams' talk show, where she told how her chest grew from 34 inches (86 cm) to 52.5 inches (133 cm) in five months during her pregnancy. Her breast growth was incipient to pregnancy. At their largest, one breast weighed 15 pounds (6.8 kg) and the other 12 pounds (5.4 kg). Her husband custom made a special bra to support her breasts. In 2007, a Chilean TV station covered the story of 32-year-old Jasna 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 4.250 kilograms (9.37 lb) from one breast and 3.330 kilograms (7.34 lb) from the other breast.[18]

On October 29, 2009, the Philippine television network GMA News and Public Affairs, producers of Wish Ko Lang (Just My Wish) hosted by Vicky Morales, profiled the story of Pilma, a 30-year-old woman afflicted by gigantmastia. The woman was told by a folk healer that her condition may have been caused by a curse. Her breasts weighed as much as two children. She had breast reduction surgery performed, but her breasts regrew. The producers of Wish Ko Lang paid for additional surgery.[19]

Virginal breast hypertrophy

In 1993, The Japanese journal Surgery Today reported on the case of a 12-year-old girl. Only 152 centimetres (60 in) tall and weighing 43 kilograms (95 lb), her breasts began to develop at age 11 before the onset of menstruation. Over the next eight months, both breasts grew abnormally large. 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 cause by hypersensitivity to estrogen. She underwent a bilateral reduction mammoplasty. Surgeons removed 2 kilograms (4.4 lb) of tissue from her right breast and 1.9 kilograms (4.2 lb) from her left breast. She was administered tamoxifen afterward to suppress breast regrowth.[20]

Seattle resident Kelly Boganwright had very large breasts as a teenager. "Every couple of days I had a horribly bad headache." Her back and neck hurt, too. Prior to breast reduction surgery she was a 36-DDD.[10] At 15 years old, Lauren Tyner, also from the Seattle area, wore a bra size of 36-HH, when she decided with her mother's assistance to get her breasts reduced.[10]

In 2005, a woman reported that at puberty her breasts grew 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 10 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.[5]

Social considerations

Extremely large breasts, also known as macromastia[21] or gigantomastia, are a source of considerable attention. Some women try to hide or mask their breasts with special clothing, including minimizing brassieres. Females may be subject to unwanted attention and psychological problems. Depression is common among sufferers.

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."[20] 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 "Hey, 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," Frye said.[22]

Fifteen-year-old Lauren Tyner commented, "I can’t even count how many rude comments or times of unwanted attention I’ve gotten because of my breasts," she said. "You’re self-conscious about everything you do. I came home crying a couple of times. And it was just getting ridiculous to shop."[10]

Finding large bra sizes and styles that fit is challenging. Also, larger bras are more costly, and can be challenging to find, not to mention they can be 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.

References

  1. ^ a b Note: the criterium of >600g is used with the term "macromastia" in this source: Sharma MD, K; S Nigam MD, Nita Khurana MD and K Uma Chaturvedi MD (2004). "Unilateral gestational macromastia- a rare disorder". Malaysian Journal of Pathology (India: Department of Pathology, Maulana Azad Medical College, Lok Nayak Hospital, Delhi) 26 (2): 125–128. http://www.mjpath.org.my/past_issue/MJP2004.2/08macromastia.pdf. Retrieved 3-22-2010. 
  2. ^ Palmuth, T (1648). Observations medicuarum centinae tres posthumae. Cent II. Braunschweig. 
  3. ^ Ohlsén, L.; O. Ericsson and M. Beausang-Linder (November, 1996). "Rapid, massive and unphysiological breast enlargement". European Journal of Plastic Surgery (Heidelberg: Springer Berlin) 9 (6). ISSN 0930-343X. 
  4. ^ "Puberty Stages of Development". Ask the Expert FAQs. OBGYN.net. http://www.obgyn.net/yw/yw.asp?page=/yw/puberty_QnA. Retrieved 2006-11-21. 
  5. ^ a b c d e Casciola, Cheri (June–July 2005). "Gigantomastia". Leaven (Chandler, Arizona) 41 (3): 62–63. http://www.llli.org/llleaderweb/LV/LVJunJul05p62.html. Retrieved October 26, 2009. 
  6. ^ Baker SB, Burkey BA, Thornton P, LaRossa D (May 2001). "Juvenile gigantomastia: presentation of four cases and review of the literature". Ann Plast Surg 46 (5): 517–25; discussion 525–6. PMID 11352426. http://meta.wkhealth.com/pt/pt-core/template-journal/lwwgateway/media/landingpage.htm?issn=0148-7043&volume=46&issue=5&spage=517. 
  7. ^ Bloom, MD, Sara A.; Maurice Y. Nahabedian, MD, FACS. "Gestational Macromastia: A Medical and Surgical Challenge". The Breast Journal (Washington, District of Columbia: Department of Plastic Surgery, Georgetown University) 11 (5): 492–495. doi:10.1111/j.1524-4741.2008.00628.x. http://www3.interscience.wiley.com/journal/120848154/abstract?CRETRY=1&SRETRY=0. Retrieved October 26, 2009. 
  8. ^ Kulkarni, Dhananjay; N. Beechey-Newman, H. Hamed and I.S. Fentiman (February 2006). Gigantomastia: A problem of local recurrence. The Breast. pp. 100–102. 
  9. ^ Swelstad MR, Swelstad BB, Rao VK, Gutowski KA (September 2006). "Management of gestational gigantomastia". Plast. Reconstr. Surg. 118 (4): 840–8. doi:10.1097/01.prs.0000232364.40958.47. PMID 16980844. http://meta.wkhealth.com/pt/pt-core/template-journal/lwwgateway/media/landingpage.htm?issn=0032-1052&volume=118&issue=4&spage=840. 
  10. ^ a b c d e Nicol, Eileen (2006). "Too Much of a Good Thing?". Caliope Publishing Company. http://www.seattlewomanmagazine.com/articles/oct06-2.htm. Retrieved 23 March 2010. 
  11. ^ Juan, Ph.D., Stephen. "Is it true that a woman's breasts can grow enormously overnight?". The Register U.K.. http://www.theregister.co.uk/2007/01/13/the_odd_body_gigantomastia/. Retrieved 2009-09-12. 
  12. ^ Durston, W (1670). "Concerning the Death of the Bigg-breasted Woman". Philosophical Transactions (Royal Society of London) (1068). doi:10.1098. http://rstl.royalsocietypublishing.org/content/4/45-56/1068.full.pdf+html. 
  13. ^ Qua, Lam (April 17, 1848). "Peter Parker Collection". Medical Historical Library, Cushing/Whitney Medical Library. http://www.med.yale.edu/library/historical/parker/lamqua16.html. Retrieved 21 March 2010. 
  14. ^ Juan, Stephen (January 13, 2007). "Is it true that a woman's breasts can grow enormously overnight?". http://www.theregister.co.uk/2007/01/13/the_odd_body_gigantomastia/. Retrieved 21 March 2010. 
  15. ^ "A 38kg skin-reducing bilateral masectomy: a unique case". http://assets0.pubget.com/pdf/18694661.pdf. 
  16. ^ "A dramatic case in a Macedonian woman". http://www.antevski.com.mk/Default.htm. 
  17. ^ a b "Macedonia faces 'giant' breast problem". http://www.austriantimes.at/index.php?id=8977. 
  18. ^ "Jasna Galleguillos" (in Spanish). TVN. 2007. http://www.dailymotion.com/video/x79i34_mexi-huge_people. Retrieved 22 March 2010. 
  19. ^ "Pilma's heavy burden". October 29, 2009. http://www.gmanews.tv/story/175871/pilma39s-heavy-burden. Retrieved 22 March 2010. 
  20. ^ a b Morimoto, Tadaoki; Kansei Komaki, Toshiaki Mori, Mii'sunori Sasa, Hitoshi Miki, Hiroyuki Inoue, Yasumasa Monden, and Hideki Nakanishi (Spring 1993). "Juvenile Gigantomastia: Report of a Case". Surgery Today of Japan: 260–264. 
  21. ^ http://macromastia.proboards.com/index.cgi
  22. ^ Rosen, Marjorie (April 26, 1993). "Now I Can Be Free". Vol. 39, No. 16. People Magazine. http://www.people.com/people/archive/article/0,,20110250,00.html. Retrieved 2009-09-12. 

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