Severe Juvenile Gigantomastia in a 12-Year-Old Girl: Case Report and Surgical Management

Abstract

Juvenile gigantomastia is a rare condition in pediatric patients, and its pathogenesis remains poorly understood. Differential diagnosis is essential to exclude other conditions, including fibroadenoma, fibrocystic disease, phyllodes tumor, malignant breast tumors, obesity-related macromastia, and endocrine disorders. We report the case of a 12-year-old premenarchal girl who developed rapid and severe bilateral breast enlargement that significantly interfered with her physical activity and caused marked psychosocial distress, ultimately leading her to leave school. Hormonal evaluation, pituitary magnetic resonance imaging (MRI), and pelvic ultrasound (US) findings were normal. Breast ultrasound revealed dysplastic glandular tissue and multiple small fluid-filled cysts. Mammography showed no suspicious calcifications; however, accurate evaluation was limited because of the high density of the breast tissue, and a neoplastic lesion could not be excluded. Histological examination demonstrated fibroadenomatosis with vascular proliferation without atypia (B2). Medical therapy with tamoxifen was initiated before surgery in an attempt to reduce breast growth, but no clinical improvement was observed. At 13 years of age, the patient underwent bilateral reduction mammoplasty using an amputation technique with free nipple–areolar complex grafting. A total of 2400 g and 2000 g of tissue were removed from the right and left breasts, respectively, without postoperative complications. Histological analysis confirmed the diagnosis of virginal macromastia. Two years later, the patient underwent bilateral mastoplasty and right reduction mammoplasty to improve breast symmetry. Following surgical treatment, she was able to resume normal social and daily activities. We report this case because of the exceptional severity of the gigantomastia and its major impact on the quality of life of this very young patient. Surgical management represents the first-line treatment for severe juvenile gigantomastia.

Keywords: Macromastia; Gigantomastia; Teenager; Reduction Mammoplasty.