A multi-disciplinary approach to gestational gigantomastia management: a case report

Background: There has yet to be a consensus definition for gestational gigantomastia or its management. Gestational gigantomastia occurs when either one or both breasts become grossly enlarged, hindering a woman's quality of life during pregnancy. The management of gestational gigantomastia has evolved with the implementation of multidisciplinary care between medicine, obstetrics, anesthesia, and surgery. Prior management included early induction or termination of pregnancy. However, our case report corroborates that definitive management with surgery can be safely carried out during pregnancy with optimization of surgical timing to mitigate maternal and fetal harm. Case Description: This was a unique case of gestational gigantomastia in a 34-year-old Caucasian woman G8P2 who was 18 weeks pregnant with no prior history of gestational gigantomastia and two prior pregnancies carried to term. She had a history of recurrent fetal loss secondary to chromosomal abnormalities, a proposed risk factor of gestational gigantomastia and presented to the emergency department in October 2022 with progressive gestational gigantomastia resulting in severe pain, inability to ambulate and worsening bilateral breast skin necrosis. Following failed conservative management with bromocriptine, she underwent a bilateral palliative mastectomy and went on to have a successful delivery at term and an uncomplicated postoperative course. Conclusions: Often, medical management of gestational gigantomastia with bromocriptine is unsuccessful and there is hesitancy to proceed with surgery in the setting of pregnancy. Based on our experience, surgery is the optimal management for women with gestational gigantomastia who are not near term for delivery. This decision should be made in the setting of a multidisciplinary team as bilateral mastectomy or delivery are optimal treatment options depending on gestational age.