A Rare “Big” Problem: A Case Study of Gestational Gigantomastia

Abstract

Aim: Gestational gigantomastia (GG) is an extremely rare condition, with an estimated global incidence rate of approximately 1 in 100,000. This case report aims to examine possible aetiologies of GG and discuss treatment strategies, with a focus on managing its symptoms and achieving a safe pregnancy to full term. Presentation of Case: We report a case of a 32-year old female at 37 weeks of gestation who presented with rapidly increasing bilateral breast enlargement accompanied with severe back pain, resulting in significant functional impairment. Breast ultrasonography showed heterogenous breast parenchyma with a well-defined heterogenous breast lesion in the right breast. On examination, both breasts were grossly enlarged, tense, tender, with excoriation of the infra-mammary folds. Foetal assessment showed intrauterine growth retardation (IUGR), however amniotic fluid index (AFI) was within normal range. The initial management strategy was for early elective delivery. However, the patient entered spontaneous labour and delivered a healthy baby boy with a normal birth weight. During the immediate post-partum period, there was marked reduction in size of both breasts and significantly improved symptoms. Discussion: The aetio-pathology of GG is not yet fully understood and is hypothesized to be linked to hormonal imbalance, auto-immune diseases or malignancy. The management of this condition should be focused on symptomatic relief, prevention of complications in order to carry the pregnancy to term safely and to prevent recurrence in future pregnancies. Conclusion: Although GG poses minimal risk to the unborn foetus, it can significantly impact the mother’s physical and psycho-social well-being. Early referral to a specialised centre is crucial to effectively manage this rare condition, and optimise maternal and foetal outcomes.