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Multi-modal Management of Gestational Gigantomastia
Angela T. Prescott, MD
Carolyn De La Cruz, MD
University of Pittsburgh Medical Center (UPMC)
2020-02-15
Presenter: Angela T. Prescott
Affidavit:
Approved by program director, reflecting 100% of the residents original work.
Director Name: Vu T. Nguyen
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: Breast (Aesthetic and Recon.)
Gestational gigantomastia is a rare condition during pregnancy resulting in rapid hypertrophy of breast tissue (over 1500 grams per breast), arising from endocrine, malignant, or idiopathic etiologies. Due to significant breast enlargement, additional stress and anxiety are inflicted on affected patients. Along with maternal/fetal supportive care, first-line treatments are pharmacologic to combat the breast hormonal growth response. Surgical breast reduction is reserved for patients who become medically unstable due to complications associated with gigantomastia, however fluid shifts and operative blood loss can be catastrophic.
Case report: A 31 year old primigravid female at 21 weeks gestation developed characteristic rapid breast hypertrophy and painful ulcerations of her bilateral breasts. After 24 weeks gestation, her ulcerations had worsened, necessitating intravenous pain control. Her pregnancy was managed by the high-risk obstetricians and plastic surgeons managed her gigantomastia and concomitant breast wounds by multi-modal approach. In addition to pharmacologic treatment (described in the literature), our recommendations included manual lymphatic drainage (MLD) four times per day, elevation of breasts, custom-made breast compression garments, aggressive wound care, and control of her hemorrhagic and colonized ulcerations. Our patient successfully underwent delivery at 31 weeks by cesarean section. Four months postpartum, the patient's breast involution had stabilized and she underwent reduction mammaplasty by amputation technique (under breast tourniquet) with free nipple grafting. Resection weights were as follows: left breast 4,320 grams; right breast 4762 grams. We present our experience using a multi-modal approach for this rare case of gestational gigantomastia.
