Avoiding Complications in Gigantomastia

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Key points

  • Gigantomastia represents extreme hypertrophy of the female breast.

  • Although there is no universally accepted definition, the amount of tissue resected during reduction mammaplasty is the most widely used description, with threshold ranges reported between 1000 g and 2000 g per breast.

  • Gigantomastia is a complicated problem that presents unique challenges. Understanding the cause of the disease and the necessary preoperative workup will minimize complications from the operation.

  • There are multiple

Definition

The amount of tissue resected during a reduction mammaplasty is often used as a marker and definition for gigantomastia. However, there is wide disagreement about how much excised tissue weight constitutes gigantomastia, with ranges between 1000 g per breast and as high as 2000 g per breast reported in the literature.6, 7, 8, 9 Definitions focusing on body mass index (BMI), brassiere size, and breast size also exist. In an attempt to standardize the categorization of gigantomastia, Dancey and

Causes

There are several different causes for gigantomastia. The most common cause is idiopathic2, 3 (Box 1). This condition can also be seen in association with pregnancy and puberty. Pregnancy-induced gigantomastia occurs with an incidence of approximately 1 in 65,000 pregnancies. Characteristic features of puberty- and pregnancy-induced gigantomastia include glandular hyperplasia, hyperplasia of the stromal elements, and fibrosis.4 There are also reports of gigantomastia developing as a result of

Anatomy

Gross12 (Fig. 1)

  1. There are certain key features that are present in patients with macromastia and gigantomastia. These features include severe ptosis, increased sternal notch to nipple distance, increased nipple to inframammary fold (IMF) distance, increased areolar size, and a broadened base. Understanding the vascular supply to the nipple-areola complex (NAC) is imperative for a safe and effective operation. The NAC is supplied by the internal mammary artery, lateral thoracic artery at the level of the fourth

Evaluation

All women presenting with severe breast hypertrophy require a complete history and physical examination. A thorough weight history should be obtained, including weight loss surgery, lowest/highest/current weight, and how breast size has changed with weight. In addition, history of any breast abnormalities, including masses and/or prior surgeries, should be obtained.1, 14 Breastfeeding history should be discussed as well as any future plans for breastfeeding, which could be compromised by

Summary

Gigantomastia is a debilitating condition both physically and emotionally. Historically, the most dependable procedure for this condition was free nipple grafting. However, newer case series have shown that nipple transposition in conjunction with pedicle-based reductions can achieve equivalent to better results. The most frequent complications following gigantomastia reductions are wound healing issues that are usually self-limited and heal well with local wound care. Specific guidelines for

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