Unilateral gestational macromastia--a rare disorder

Area of Science:

• Obstetrics and Gynecology
• Surgical Pathology

Background:

• Macromastia, or massive breast enlargement, can occur unilaterally or bilaterally and is disproportionate to overall body growth.
• Gravid macromastia or gigantomastia of pregnancy specifically refers to breast enlargement during gestation, which may or may not resolve postpartum.

Observation:

• A 28-year-old female presented four months postpartum with a painful, massive enlargement of her left breast, which began during the third trimester of pregnancy.
• The affected breast exhibited stretched skin with ulcerations and foul-smelling discharge. Initial fine needle aspiration cytology suggested a phylloides tumor.

Findings:

• A simple mastectomy was performed. The excised specimen measured 30 x 30 x 9 cm and was entirely replaced by abnormal tissue, with all resection margins involved.
• Histopathological examination revealed periductal and diffuse fibrosis, adenosis, and lactational changes. Crucially, no evidence of phylloides tumor or carcinoma was found.

Implications:

• The case was diagnosed as unilateral gestational macromastia, highlighting its extreme rarity and the importance of thorough histopathological evaluation to differentiate it from neoplastic conditions.
• This case underscores the diagnostic challenges and management considerations for gestational macromastia, particularly when presenting postpartum with concerning clinical signs.