Download PDF
CC BY-NC-ND 4.0 · Arch Plast Surg 2022; 49(03): 369-372
DOI: 10.1055/s-0042-1748651
Breast/Trunk
Case Report

Gigantomastia as a Cause of Pulmonary Hypertension

Juan Pablo Castillo
1   Facultad de Ciencias de la Salud, Grupo de investigación PLASTICUV Cali, Universidad del Valle, Cali, Colombia
,
Ana María Robledo
1   Facultad de Ciencias de la Salud, Grupo de investigación PLASTICUV Cali, Universidad del Valle, Cali, Colombia
2   Plastic Surgery Service, Hospital Universitario del Valle, Cali, Colombia
,
Laura Torres-Canchala
3   Facultad de Ciencias de la Salud, Universidad Icesi, Cali, Colombia
,
Lady Roa-Saldarriaga
1   Facultad de Ciencias de la Salud, Grupo de investigación PLASTICUV Cali, Universidad del Valle, Cali, Colombia
2   Plastic Surgery Service, Hospital Universitario del Valle, Cali, Colombia
› Author Affiliations
› Further Information
   Permissions and Reprints

Abstract

Reduction mammaplasty is the gold standard treatment for gigantomastia. We report one female patient with juvenile gigantomastia associated with severe pulmonary hypertension where her pulmonary pressure decreased significantly after the surgery, improving her quality of life. A 22-year-old female patient with gigantomastia since 10 years old, tricuspid regurgitation, and pulmonary thromboembolism antecedent was admitted to the emergency department. Her oxygen saturation was 89%. Acute heart failure management was initiated. An echocardiogram reported left ventricle ejection fraction (LVEF) of 70% with severe right heart dilation, contractile dysfunction, and arterial pulmonary pressure (PASP) of 110 mm Hg. A multidisciplinary team considered gigantomastia could generate a restrictive pattern, so a Thorek reduction mammoplasty with Wise pattern was performed. Presurgical measurements were: sternal notch to nipple-areola complex, right 59 cm, left 56 cm. Three days after surgery, the patient could breathe without oxygen support. In the outpatient follow-up, patient referred reduction of her respiratory symptoms and marked improvement in her quality of life. Six months after surgery, a control echocardiogram showed a LVEF of 62% and PASP of 85 mm Hg. Pulmonary hypertension may be present in patients with gigantomastia. Reduction mammoplasty may be a feasible alternative to improve the cardiac signs and symptoms in patients with medical refractory management.

Keywords

gigantomastia - mammoplasty reduction - pulmonary hypertension

Authors Contributions

J.P.C. and A.M.R. conceived the study, designed the study, and obtained ethics approval. J.P.C. and L.R.S. were involved in all aspects of the paper generation and revised each draft and coordinated all coauthors' activities. L.R.S. collected all the data. J.P.C., L.R.S., and L.T.C. wrote the different versions. L.R.S. also prepared the figures. All authors provided critical input into all aspects of the design and execution of the study and participated in all phases of the study.


Patient Consent

Informed consent was obtained from all individual participants included in the study.




Publication History

Article published online:
27 May 2022

© 2022. The Korean Society of Plastic and Reconstructive Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Nuzzi LC, Firriolo JM, Pike CM. et al. The effect of reduction mammaplasty on quality of life in adolescents with macromastia. Pediatrics 2017; 140 (05) e20171103
    CrossrefPubMedGoogle Scholar
  • 2 Dancey A, Khan M, Dawson J, Peart F. Gigantomastia–a classification and review of the literature. J Plast Reconstr Aesthet Surg 2008; 61 (05) 493-502
    CrossrefPubMedGoogle Scholar
  • 3 Kececi Y, Dagistan S. Effects of breast reduction on pulmonary function. Int Surg 2014; 99 (04) 300-304
    CrossrefPubMedGoogle Scholar
  • 4 Starley IF, Bryden DC, Tagari S, Mohammed P, Jones BP. An investigation into changes in lung function and the subjective medical benefits from breast reduction surgery. Br J Plast Surg 1998; 51 (07) 531-534
    CrossrefPubMedGoogle Scholar
  • 5 Cunha MS, Santos LL, Viana AA, Bandeira NG, Filho JAL, Meneses JVL. Avaliação da função pulmonar em pacientes submetidas à mastoplastia redutora. Rev Col Bras Cir 2011; 38 (01) 11-14
    CrossrefPubMedGoogle Scholar
  • 6 Rogliani M, Gentile P, Labardi L, Donfrancesco A, Cervelli V. Improvement of physical and psychological symptoms after breast reduction. J Plast Reconstr Aesthet Surg 2009; 62 (12) 1647-1649
    CrossrefPubMedGoogle Scholar
  • 7 Menekşe E, Önel S, Karateke F. et al. Virginal breast hypertrophy and symptomatic treatment: a case report. J Breast Health 2014; 10 (02) 122-124
    CrossrefPubMedGoogle Scholar
  • 8 Lonie S, Sachs R, Shen A, Hunter-Smith DJ, Rozen WM, Seifman M. A systematic review of patient reported outcome measures for women with macromastia who have undergone breast reduction surgery. Gland Surg 2019; 8 (04) 431-440
    CrossrefPubMedGoogle Scholar
  • 9 Thorek M. Plastic reconstruction of the breast and free transplantation of the nipple. J Int Coll Surg 1946; 9: 194-224
    PubMedGoogle Scholar
  • 10 Ayinapudi K, Singh T, Motwani A, Le Jemtel TH, Oparil S. Obesity and pulmonary hypertension. Curr Hypertens Rep 2018; 20 (12) 99
    CrossrefPubMedGoogle Scholar
  • 11 Alpert MA, Karthikeyan K, Abdullah O, Ghadban R. Obesity and cardiac remodeling in adults: mechanisms and clinical implications. Prog Cardiovasc Dis 2018; 61 (02) 114-123
    CrossrefPubMedGoogle Scholar
  • 12 Ceber M, Yuksek A, Mutlu LC, Bali I, Topcu B. Reduction mammaplasty effect on pulmonary function and arterial blood gas in the overweight female. Aesthetic Plast Surg 2015; 39 (04) 540-546
    CrossrefPubMedGoogle Scholar
  • 13 Onuk AA, Senen D, Arslan B, Muslu U, Tek M, Karslı B. Effects of bilateral breast reduction on peak airway pressure and pulmonary function tests. Niger J Clin Pract 2018; 21 (08) 949-953
    PubMedGoogle Scholar