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Gestational Gigantomastia Induced Hypercalcemia via Parathyroid Related Protein: A Case Report and Review of Literature
Payton J. Sparks BS, Jasmine Higgins, MS, MPH, Alan Tom MD, Harley L. Moit DO, Aladdin H. Hassanein MD, MMSc, Diane M. Donegan, MB Bch BAO, Lisa Korff MD, Ivan Hadad MD, FACS
Indiana University School of Medicine - Division of Plastic Surgery, Indiana University, Indianapoli
2024-01-14
Presenter: Payton Sparks
Affidavit:
The majority of the writing and data compilation of this project was completed by Payton Sparks.
Director Name: Dr. Ivan Hadad MD, FACS
Author Category: Medical Student
Presentation Category: Clinical
Abstract Category: Breast (Aesthetic and Recon.)
Gestational gigantomastia is characterized by rapid breast tissue enlargement in pregnancy, occasionally leading to severe hypercalcemia secondary to elevated parathyroid hormone related protein (PTHrP). While mastectomy has been previously described, it posed significant blood loss risks. Herein, we review these previous cases and discuss our experience using advanced surgical techniques to enable safer bilateral mastectomy with minimal blood loss. A 39-year-old, 19-week pregnant female, with class III obesity and HIV, presented with symptomatic hypercalcemia, suppressed parathyroid hormone (PTH), and elevated PTHrP levels. After failed medical therapy, bilateral mastectomy was performed. A skin sparing no vertical scar reduction skin pattern was utilized. Tumescent solution, in combination with electrocautery and energy-based vessel sealing devices (Impact LigaSure, Medtronic, Minneapolis) were used to remove bilateral breasts, noting large subcutaneous veins and dense engorged breast parenchyma, which was not violated. A separate focus of accessory breast tissue was additionally removed from the left axilla. Following the bilateral mastectomy, calcium levels normalized and PTHrP levels were undetectable 12 hours after surgery. No further medical management of hypercalcemia was required. The patient had an uneventful remaining postoperative course and pregnancy. Bilateral mastectomy can be performed safely for mother and fetus, with modern surgical technological advancements and result in an immediate chemical cure for this rare cause of hypercalcemia. This case adds to the small series of cases documenting this rare condition of PTHrP-mediated hypercalcemia secondary to gestational gigantomastia, demonstrating that surgery can be done safely, quickly, and with relatively minor blood loss.
