Macedonian Woman

We present an extreme case of Gigantomastia in pregnancy in a 24-year old woman, gravida 2, in a 28 weeks' of gestation, with a total breast weight of 33 kg, complicated by infection, ulcerations and subsequent hemorrhage. Thorough laboratory analyses did not reveal any hint as to the cause of this enormous breast enlargement. Gynecological examinations and ultrasound revealed a viable, progressive normal fetus. The severity of the problem is further emphasized by the patients' breathing problems and even big difficulty in standing and walking. We performed bilateral simple mastectomy as a life-saving procedure to prevent fatal complications. The procedure finished without any complications or large amount of blood loss. There are less than 100 cases of gravid gigantomastia reported, but never to such extreme breast weight. Etiology remains uncertain, and controversy exists in therapeutic modality. According to the literature the most reliable conservative treatment is bromocriptine therapy, but if the condition progresses surgical intervention, in the form of reduction mammoplasty or simple mastectomy, is the treatment of choice.

A 24-year-old woman was admitted on August 28, 2003, gravida 2, in 28 weeks` gestation. She was complaining of huge enlargement of both her breasts, pain and discomfort. This enlargement started at 21 weeks` gestation and continued to increase rapidly as the pregnancy progressed, complicated by infection, ulcerations, and subsequent hemorrhage.
Three years ago, she had induced abortion in 20 weeks` gestation, due to intrauterine fetal death of unknown etiology, without any pathologically confirmed macroscopical and microscopical fetal malformations. During her first pregnancy no significant enlargement of the breast was noted, and also, there was no significant personal medical or family history.

When Afrodita Kamberi’s breasts began growing during her sixth pregnancy she wasn’t too worried. In her five previous pregnancies, she’d gone up from her 34D cup to a size EE, but this time she realised something was wrong when they kept growing – becoming a huge ZZZ cup!

“I couldn’t sleep at night, but I was in so much pain I just had to lie down all the time,” says Afrodita, 29, whose breasts ended up weighing 4 1⁄2st before doctors removed them in a seven-hour mastectomy op.

Afrodita met her husband, Arban, 31, a teacher, when they were students and they got married in 1998.

“I had pretty normal-sized breasts back then – they were a D cup and I was very happy with them,” she recalls. “I became pregnant a couple of months after we got married and obviously my breasts got bigger – but nothing out of the ordinary. The same happened with my next four pregnancies. After breastfeeding, my boobs would always return to normal size.”

But when Afrodita was pregnant with her sixth child, Lavrdim, in 2003, her breasts just kept growing. “They just got bigger and bigger,” says Afrodita, who usually weighs just over 10st. She says: “At first, my husband made
a joke of it, but even he could see it wasn’t funny when they got so big that I couldn’t walk properly!

“I went to see the doctor about it when I was about four months pregnant, but he told me they’d stop growing soon. Looking after the children was becoming impossible and I felt like a freak when I went outside – people stared and pointed at me.”

By the last month of her pregnancy, Afrodita was so uncomfortable, she begged a specialist for help at her local hospital in Skopje, Macedonia. “The doctor diagnosed a condition called gigantomastia. He said it was incredibly rare and potentially very dangerous,” she says.

“He told me it mainly affected pregnant women, and the only option was to operate. “Removing my breasts was risky as there could be severe blood loss. I weighed up the risks, but I knew I couldn’t carry on like that.

“I knew that going under anaesthetic might pose a slight risk to my unborn baby – but I had to have my breasts removed before I gave birth and my milk kicked in, which would make them even bigger.”

“I went into hospital a few weeks before the baby was due. The cost of the operation was covered by health insurance.”

Although Afrodita was left with no breasts and severe scarring, she says she felt nothing but relief. She reveals: “Afterwards I felt so much better even though my chest was a mess. It was horribly scarred, but I don’t regret it. My husband is fine with how I look and we still have a normal love life. We even had another child in 2004. I couldn’t breastfeed her, but at least I could pick her up!”