Gigantomastia
Encyclopedia
Hypertrophy of the breast (macromastia and gigantomastia) is a rare disease of the breast
Breast
The breast is the upper ventral region of the torso of a primate, in left and right sides, which in a female contains the mammary gland that secretes milk used to feed infants.Both men and women develop breasts from the same embryological tissues...

 connective tissues; the indication is a breast weight increase that exceeds 600 grams (21.2 oz), which enlargement causes muscular discomfort and over-stretching of the skin envelope, leading to ulceration
Ulcer
An ulcer is a sore on the skin or a mucous membrane, accompanied by the disintegration of tissue. Ulcers can result in complete loss of the epidermis and often portions of the dermis and even subcutaneous fat. Ulcers are most common on the skin of the lower extremities and in the gastrointestinal...

. Hypertrophy of the breast tissues might be caused by increased histologic
Histology
Histology is the study of the microscopic anatomy of cells and tissues of plants and animals. It is performed by examining cells and tissues commonly by sectioning and staining; followed by examination under a light microscope or electron microscope...

 sensitivity to the female hormone
Hormone
A hormone is a chemical released by a cell or a gland in one part of the body that sends out messages that affect cells in other parts of the organism. Only a small amount of hormone is required to alter cell metabolism. In essence, it is a chemical messenger that transports a signal from one...

s prolactin
Prolactin
Prolactin also known as luteotropic hormone is a protein that in humans is encoded by the PRL gene.Prolactin is a peptide hormone discovered by Henry Friesen...

, estrogen
Estrogen
Estrogens , oestrogens , or œstrogens, are a group of compounds named for their importance in the estrous cycle of humans and other animals. They are the primary female sex hormones. Natural estrogens are steroid hormones, while some synthetic ones are non-steroidal...

, and progesterone
Progesterone
Progesterone also known as P4 is a C-21 steroid hormone involved in the female menstrual cycle, pregnancy and embryogenesis of humans and other species...

; or an abnormally elevated hormone(s) level in the blood, or both. Macromastia is the bilateral, benign progressive enlargement of the breasts; gigantomastia was first scientifically described in 1648.

General condition

Hypertrophy of the breast can affect the breasts equally, but usually affects one breast more than the other, thereby causing asymmetry, when one breast is larger than the other. The condition can also individually affect the nipples and areola
Areola
This article is about the breast tissue. For the entomology term, see the glossary of Lepidopteran terms. For an artistic cloud motif, see aureola. For the cactus feature, see Areole....

 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
Puberty
Puberty is the process of physical changes by which a child's body matures into an adult body capable of reproduction, as initiated by hormonal signals from the brain to the gonads; the ovaries in a girl, the testes in a boy...

 (virginal hypertrophy), gestational (gravid
Pregnancy
Pregnancy refers to the fertilization and development of one or more offspring, known as a fetus or embryo, in a woman's uterus. In a pregnancy, there can be multiple gestations, as in the case of twins or triplets...

 macromastia), in adult women without any obvious cause, associated with penicillamine
Penicillamine
Penicillamine is a pharmaceutical of the chelator class. It is sold under the trade names of Cuprimine and Depen. The pharmaceutical form is D-penicillamine, as L-penicillamine is toxic...

 therapy, and associated with extreme obesity
Obesity
Obesity is a medical condition in which excess body fat has accumulated to the extent that it may have an adverse effect on health, leading to reduced life expectancy and/or increased health problems...

. The underlying cause of the rapidly growing breast connective tissue, resulting in gigantic proportions, is thought to be a heightened sensitivity to female hormone
Hormone
A hormone is a chemical released by a cell or a gland in one part of the body that sends out messages that affect cells in other parts of the organism. Only a small amount of hormone is required to alter cell metabolism. In essence, it is a chemical messenger that transports a signal from one...

s prolactin
Prolactin
Prolactin also known as luteotropic hormone is a protein that in humans is encoded by the PRL gene.Prolactin is a peptide hormone discovered by Henry Friesen...

, estrogen
Estrogen
Estrogens , oestrogens , or œstrogens, are a group of compounds named for their importance in the estrous cycle of humans and other animals. They are the primary female sex hormones. Natural estrogens are steroid hormones, while some synthetic ones are non-steroidal...

 and progesterone
Progesterone
Progesterone also known as P4 is a C-21 steroid hormone involved in the female menstrual cycle, pregnancy and embryogenesis of humans and other species...

.

Virginal breast hypertrophy

When gigantomastia occurs in young women during puberty
Puberty
Puberty is the process of physical changes by which a child's body matures into an adult body capable of reproduction, as initiated by hormonal signals from the brain to the gonads; the ovaries in a girl, the testes in a boy...

, 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
Thelarche
Thelarche is the onset of secondary breast development, usually occurring at the beginning of puberty in girls. Its etymology is from Greek θηλή [tʰelḗ], “nipple” and ἀρχή [arkʰḗ], “beginning, onset”. Thelarche is usually noticed as a firm, tender lump directly under the centre of the nipple...

 occurs before onset of menstruation
Menarche
Menarche is the first menstrual cycle, or first menstrual bleeding, in female human beings. From both social and medical perspectives it is often considered the central event of female puberty, as it signals the possibility of fertility....

.

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. Women suffering VBH often experience an excessive growth of their nipples. In severe cases of VBH, hypertrophy of the clitoris occurs.

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.

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. 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
Mastitis
Mastitis is the inflammation of breast tissue. S. aureus is the most common etiological organism responsible, but S. epidermidis and streptococci are occasionally isolated as well.-Terminology:...

.

Medical treatment

Medical treatment has not proven consistently effective. Medical regimens have included tamoxifen
Tamoxifen
Tamoxifen is an antagonist of the estrogen receptor in breast tissue via its active metabolite, hydroxytamoxifen. In other tissues such as the endometrium, it behaves as an agonist, hence tamoxifen may be characterized as a mixed agonist/antagonist...

, progesterone
Progesterone
Progesterone also known as P4 is a C-21 steroid hormone involved in the female menstrual cycle, pregnancy and embryogenesis of humans and other species...

, bromocriptine
Bromocriptine
Bromocriptine , an ergoline derivative, is a dopamine agonist that is used in the treatment of pituitary tumors, Parkinson's disease , hyperprolactinaemia, neuroleptic malignant syndrome, and type 2 diabetes.- Indications :Amenorrhea, female infertility, galactorrhea, hypogonadism, and acromegaly...

, and testosterone
Testosterone
Testosterone is a steroid hormone from the androgen group and is found in mammals, reptiles, birds, and other vertebrates. In mammals, testosterone is primarily secreted in the testes of males and the ovaries of females, although small amounts are also secreted by the adrenal glands...

. Surgical therapy includes reduction mammaplasty
Breast reduction
Reduction mammoplasty is the plastic surgery procedure for correcting over-sized breasts...

 and mastectomy
Mastectomy
Mastectomy is the medical term for the surgical removal of one or both breasts, partially or completely. Mastectomy is usually done to treat breast cancer; in some cases, women and some men believed to be at high risk of breast cancer have the operation prophylactically, that is, to prevent cancer...

. However, breast reduction
Breast reduction
Reduction mammoplasty is the plastic surgery procedure for correcting over-sized breasts...

 is not clinically indicated unless at least 4 pounds (1.8 kg) of tissue per breast needs to be removed. 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.

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
Breast reduction
Reduction mammoplasty is the plastic surgery procedure for correcting over-sized breasts...

 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.

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
Breast reduction
Reduction mammoplasty is the plastic surgery procedure for correcting over-sized breasts...

. 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
Physical therapy
Physical therapy , often abbreviated PT, is a health care profession. Physical therapy is concerned with identifying and maximizing quality of life and movement potential within the spheres of promotion, prevention, diagnosis, treatment/intervention,and rehabilitation...

 for a year or more. 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."

Gigantomastia

Gigantomastia occurs in 1 out of every 28,000 to 100,000 pregnancies. 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).

On April 17, 1848, a 42-year-old woman named Lu-shi was treated for hypertrophy in a Chinese hospital. She was treated by a missionary physician. On December 24, 1849, the left breast, measuring 2 foot 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 foot (0.6096 m) in circumference and weighed 5.5 pounds (2.5 kg).

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.

Another extreme case was observed in 2008 in Maria Vittoria Hospital in Turin, Italy, where the amount removed from both breasts was 38 kilogram. The growth occurred during puberty making it a case of juvenile gigantomastia, but the patient did not seek treatment until the age of 29. 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 kilogram total. 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 (66.1 lb) total.

As the disorder becomes more widely known, media reports have increased. French Canadian Isabelle Lanthier appeared on Montel Williams
Montel Williams
Montel Brian Anthony Williams is an American television personality, radio talk show host and actor. He is best known as host of the long-running The Montel Williams Show, and more recently as a spokesperson for the Partnership for Prescription Assistance...

' talk show, where she told how her chest grew from 34 inches (86.4 cm) to 52.5 inches (133.4 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
Antofagasta
Antofagasta is a port city in northern Chile, about north of Santiago. It is the capital of Antofagasta Province and Antofagasta Region. According to the 2002 census, the city has a population of 296,905...

, who experienced ongoing back pain, making everyday tasks very difficult to perform. She underwent breast reduction
Breast reduction
Reduction mammoplasty is the plastic surgery procedure for correcting over-sized breasts...

 surgery to relieve her pain. Surgeons removed 4.25 kilograms (9.4 lb) from one breast and 3.33 kilograms (7.3 lb) from the other breast.

On October 29, 2009, the Philippine television network GMA News and Public Affairs, producers of Wish Ko Lang
Wish Ko Lang
Wish Ko Lang ' is the first wish-granting show on Philippine television. Its pilot episode was broadcast July 2002, hosted by Bernadette Sembrano. She was later replaced by Vicky Morales after Sembrano transferred to rival network ABS-CBN...

 (Just My Wish) hosted by Vicky Morales
Vicky Morales
Victoria "Vicky" Morales-Reyno is a popular television newscaster in the Philippines. She currently co-anchors GMA Network's late-night newscast Saksi with Arnold Clavio and hosts the Saturday afternoon documentary-drama show Wish Ko Lang...

, profiled the story of Pilma, a 30-year-old woman afflicted by gigantomastia. The woman was told by a folk healer
Albularyo
Albularyo , sometimes spelled albulario, is a Tagalog term for a folk healer or medicine men.-Etymology and Alternative Names:The word arbularyo derives from herbolario, a Spanish word meaning herbalist....

 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.

Nude model Norma Stitz
Norma Stitz
Annie Hawkins-Turner , better known by the pseudonym Norma Stitz, is a website entrepreneur and fetish model. Her stage name is a word-play on the phrase "enormous tits"...

 is exploiting this condition and is officially named as being the person with the largest natural breasts by the Guiness Book of Records.

Virginal breast hypertrophy

In 1993, the Japanese journal Surgery Today reported on the case of a 12-year-old girl. Only 152 centimetres (59.8 in) tall and weighing 43 kilograms (94.8 lb), her breasts began to develop at age 11 before the onset of menstruation
Menarche
Menarche is the first menstrual cycle, or first menstrual bleeding, in female human beings. From both social and medical perspectives it is often considered the central event of female puberty, as it signals the possibility of fertility....

. 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
Kyphosis
Kyphosis , also called roundback or Kelso's hunchback, is a condition of over-curvature of the thoracic vertebrae...

. 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
Estrogen
Estrogens , oestrogens , or œstrogens, are a group of compounds named for their importance in the estrous cycle of humans and other animals. They are the primary female sex hormones. Natural estrogens are steroid hormones, while some synthetic ones are non-steroidal...

. She underwent a bilateral reduction mammoplasty
Breast reduction
Reduction mammoplasty is the plastic surgery procedure for correcting over-sized breasts...

. 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.

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. 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.

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.

Social considerations

Extremely large breasts, also known as macromastia or gigantomastia, are a source of considerable attention. Some women try to hide or mask their breasts with special clothing, including minimizing brassiere
Brassiere
A brassiere is an undergarment that covers, supports, and elevates the breasts. Since the late 19th century, it has replaced the corset as the most widely accepted method for supporting breasts....

s. Females may be subject to psychological problems due to unwanted attention and/or harassment. 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." Actress Soleil Moon Frye
Soleil Moon Frye
Soleil Moon Frye is an American actress, director and screenwriter. Frye is best known for her childhood role as the title character in sitcom Punky Brewster, and as Roxie King in Sabrina, the Teenage Witch.-Early life:...

, who starred as a child in the sitcom Punky Brewster
Punky Brewster
Punky Brewster was an American sitcom about a girl named Punky Brewster being raised by her foster parent...

, reported in an interview with People
People (magazine)
In 1998, the magazine introduced a version targeted at teens called Teen People. However, on July 27, 2006, the company announced it would shut down publication of Teen People immediately. The last issue to be released was scheduled for September 2006. Subscribers to this magazine received...

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.

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."

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 headache
Headache
A headache or cephalalgia is pain anywhere in the region of the head or neck. It can be a symptom of a number of different conditions of the head and neck. The brain tissue itself is not sensitive to pain because it lacks pain receptors. Rather, the pain is caused by disturbance of the...

s, neck pain, upper and lower back pain, and numbness or tingling in the fingers.

External links

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