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Gigantomastia is a rare condition of the breast, consisting of an excessive breast growth. If this condition occurs immediately after menarche, the condition is described as virginal gigantomastia. There is no clear established limit to define the disease, but a breast volume larger than 2.250 g is generally accepted as the lower limit of the gigantomastia.
A 14 years old patient with virginal gigantomastia and severe evolution in 6 months after menarche is presented. No similar or significant family history was noticed. Her body weight increased from 50 to 61 Kg in 5 months. Very difficult physical and psychological condition related to her breasts size grew worse during this time. The physical exam was normal, except a reactive anxious-depressive disease. The hormonal investigation 4 months after menarche when she was starting to develop macromastia were: estradiol 184 pg/mL, progesterone 0.13 ng/mL, testosterone= 0.33 ng/mL, DHEAS -135.7 ug/dL, FSH 4.21 mU/mL, LH 5.74 mU/mL, PRL 9.69 ng/mL, beta hCG 0.75 mUI/mL, CGA 41.4 ng/mL, IGF1 =313.7 ng/mL (N), SHBG- 164.4 nmol/L (27-110), urinary free cortisol 110 ug/dL; ATPO- 10 UI/mL, TSH -2.67 mUI/L, fT4 - 10 pmol/L. The only increased hormonal marker was SHBG, which might suggest an imbalance in the transport and action of estradiol more than the production itself. All the other markers showing thyroid, pituitary and ovarian functions were normal.
Before the first surgery, in March 2015 the hormonal study was as follows: estradiol 84 pg/ mL, progesterone 3.24 ng/mL, PRL 11.08 ng/mL, testosterone 0.47 ng/mL, fT4 7.43 pmol/L, TSH 0.49 mU/L. The breasts bloodless masses evaluated after surgery were 4.600 g on the right and 5.200 g on the left. The current status is good, waiting to be scheduled for reconstructive surgery.