The pathology of bilateral breast hypertrophy is generally an oversensitivity of breast tissue to circulating hormonal stimulation. Within a spectrum of enlargement, there is a distinct pathological entity, virginal breast hypertrophy. Histologically, there is an excess of fibrous tissue and fat while the glandular component remains relatively unaffected.
The differential diagnoses for unilateral breast hypertrophy are idiopathic enlargement, unilateral virginal hypertrophy, fibroadenoma, cystosarcoma phyllodes, breast hamartoma and trauma. In around 1% of cases, a diagnosis of occult breast carcinoma is made from a breast reduction specimen. This has led to recommendations that all breast tissue should be examined by a pathologist in patients older than 40 years of age (1).
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