Virginal breast hypertrophy

Virginal or juvenile breast breast hypertrophyis a rare and distinct disorder with the rapid onset of macromastia at the onset of puberty. Most patients with macromastia have breasts which develop normally at puberty but simply reach excessive size (1,2). One review revealed that 108 patients were reported in the medical literature between 1910 and 2006, and amongst these, 57 had a clear diagnosis of juvenile gigantomastia (2).

The aetiology remains elusive but it is thought to be the result of an abnormal stimulation of mammary tissue by normal levels of circulating hormones that manifests as rapid and excessive breast enlargement at any stage in the peripubertal period.

Management may include:

• tamoxifen therapy should be considered from onset of diagnosis
• a subcutaneous mastectomy with complete removal of breast tissue is the procedure least likely to lead to recurrence but is more deforming
• reduction mammaplasty has a relatively better aesthetic result compared to subcutaneous mastectomy, but it is important to counsel the patient about the likelihood of increased recurrence
• tamoxifen therapy following surgery may decrease the recurrence rate

Reference:

• 1) Kupfer D, Dingman D, Broadbent R. Juvenile breast hypertrophy: report of a familial pattern and review of the literature. Plast Reconstr Surg 1992;90:303-309.
• 2) Dancey A et al. Gigantomastia - a classification and review of the literature J Plast Reconstr Aesthet Surg 2008; 61:93
• 3) Hoppe IC et al. Virginal mammary hypertrophy: a meta-analysis and treatment algorithm. Plast Reconstr Surg. 2011 Jun;127(6):2224-31.