Gestational Gigantomastia: A Century of Evidence with a New Case

Gestational gigantomastia (GG) is an extreme, rapidly progressive breast enlargement that can culminate in ulceration, sepsis, cardiopulmonary compromise, and, when care is delayed, maternal death. Scattered case reports leave management uncertain. This study synthesizes more than a century of GG literature and contextualizes a new, complex case in context, clarifying epidemiology, pathogenesis, and treatment pathways.

Systematic searches of PubMed/MEDLINE, Embase, Ovid Global Health, Google Scholar, and French-language archives (1900-2025) identified 69 publications describing 76 GG episodes. Dual reviewers applied explicit criteria; extracted demographic, clinical, and outcome data; and assessed quality. These findings were integrated with a life-threatening GG case managed at 27 weeks' gestation.

Median presentation was 23 weeks (range 6 wk gestation to 1 wk postpartum). Ulceration (53%), hemorrhage (22%), and infection (13%) were common; 4 maternal deaths (5.1%) occurred due to delayed intervention. One-third of assays showed elevated prolactin. First-line medical therapy (bromocriptine, cabergoline, or norethindrone) achieved partial arrest in approximately 35% of trials; definitive control required surgery in 57% (reduction mammaplasty 29%, mastectomy 28%). Maternal outcomes improved when surgery preceded ulceration or systemic decompensation. Our patient recovered fully after an emergency skin-sparing mastectomy, though preterm labor ensued.

GG remains rare, yet potentially fatal. Early recognition, prompt endocrine modulation, and timely, staged surgery are critical. We provide the largest curated dataset to date, quantify the mortality risk, and propose a stepwise management algorithm to guide multidisciplinary teams confronting this formidable obstetric challenge.