Breast hypertrophy

Breast hypertrophy is a relative enlargement of breast tissue disproportionate to the frame of the individual. Usually it is bilateral and affects females. There may be asymmetry between the sides. Breast hypertrophy is a term that is used interchangeably with macromastia and gigantomastia. However, gigantomastia describes an extreme of size and one definition that has been used to arbitrarily demarcate both groups is the mass of tissue that needs to be removed at breast reduction surgery. If the mass is less than 2.5kg, the patient is deemed to have macromastia whereas if it is more than this threshold, gigantomastia is the defined category.

The pathogenesis is thought to be an oversensitivity of the breast tissue to circulating hormones such as oestrogen and progesterone, or an excessive circulating concentration of these hormones. Clinically, it occurs in one of several settings:

• developmental - virginal breast hypertrophy
• secondary hypertrophy:
  • weight gain
  • pregnancy - gravid or gestational macromastia
  • breast feeding
  • drug side effect eg penicillamine

Breast hypertrophy can cause a range of symptoms and signs:

• physical:
  • mastalgia
  • neck, shoulder and back pain
  • postural problem
  • submammary maceration
  • intertrigo, typically fungal
  • sensory symptoms in the upper limbs eg ulnar paraesthesia
  • indenting of the shoulder skin from bra straps cutting in
• psychological:
  • low self-esteem
  • depression

A number of treatments have been used for breast hypertrophy including physiotherapy, drug treatments such as tamoxifen and surgery. Surgical treatment is typically a breast reduction operation, but mastectomy has also been used for severe or recalcitrant hypertrophy. In the latter situations, any residual breast tissue may be prone to regrowth.