R. E. Pennington MD, FACS; Susan Clare MD, PhD; Armadip Bhuller MD; Ian Komenaka MD; Robert Goulet MD, FACS
This video submission for General Surgery describes a case of Pregnancy associated Gigantomastia in a 21 year old woman who presented to the Breast Surgery Clinic at Wishard Memorial Hospital in Indianapolis, IN. during the first trimester of her second pregnancy. At the time of presentation, the patient indicated that her breast enlargement had begun 9 months previously. Over this 9 month period her baseline bra size of 38D increased to 58 DDD at presentation. Her previous pregnancy 5 years ago was not associated with excessive breast growth. On examination, she was unable to wear a bra, had extreme back and shoulder pain, was unable to lie supine for examination and had bilateral open ulcerations on the inferolateral breast area. Gigantomastia of pregnancy was diagnosed.
The surgical plan was to wait until she entered the second trimester of pregnancy at which time she would undergo bilateral reduction mammoplasties. Her breast growth, pain and ulcerations progressed rapidly and she was admitted to the hospital within 3 weeks of her initial presentation. Previously present ulcers had become deeper and larger, she also developed new ulcers, parenchymal infection and periodic bleeding from the sites.
After consultation between OB, anesthesia, OR nursing and surgery, bilateral simple mastectomies were recommended and performed using a special breast suspension device that can be made up from readily available hospital equipment. Blood loss was controlled by using the Tumescent technique familiar to cosmetic surgeons. Because the tumescent solution enabled easy visualization of the tissue planes and controlled the blood loss, simple mastectomies rather than reduction mammoplasties were able to be performed. The information gathered during this patient's care could be important to other surgeons encountering the rare and extreme condition.