Large Breasts

Large breasts, Breast Hypertrophy , Macromastia, Gigantomastia.

Breasts are generally desirable and as they start to grow most females are happy. As they get larger that can be a time of great joy. However, if they start to cause pain and skin problems they may be too large.

Causes and Types

Juvenile Gigantomastia

Breast development starts at puberty. It can start early for some and be out of proportion to the rest of the body. If the breasts weight more than 5lbs each or more than 3% of body weight they are diagnosed as Juvenile Gigantomastia. Large breasts in young females will attract attention from friends and family. Some of this attention will be supportive, understanding and protective. Some attention may be negative and very harsh. This may be very difficult for an immature person to cope with.

Treatment

Treatment at this stage is supportive and symptomatic. Mothers, aunts and female family friends can help while maturity develops.

Diet is important with the target of avoiding excess weight gain, much of which will go to the breasts.

Hormone therapy can be considered with the advice of a specialist in this field.

Skin care for the breasts deserves special attention. The mammary folds (Under the breasts) are prone to friction and moisture problems. Baby powder is very helpful here. Treat any rash early.

The weight of the breasts may be considerable. Good supporting bra’s are very important.

Posture must be maintained. We all tend to stoop and this gets worse with age. Large breasts can accelerate this. Pain in the neck and shoulders from bra straps may be significant. A groove from the bra strap is a strong sign of the problem. Physical Therapists can be very helpful.

Breast reduction surgery in young females is possible and can be live changing but all other measures need to have been tried first.

Liposuction is the least invasive option. It removes excess fat without removing gland tissue. If CT scans of the breasts reveal a large gland component Vaser liposuction will be needed. Surgical excision should also be considered.

Breast Feeding

Breast feeding will make the breasts larger again. Liposuction is unlikely to affect breast feeding but surgical excision will.

Gestational Gigantomastia

If your breasts become very large with pregnancy and do not return to their normal size after pregnancy you may have Gestational Gigantomastia. Diagnostic criteria are the same: more than 5lb in each breast or more than 3% of body weight.

You may have slightly less than these numbers but if you have the signs and symptoms then you need to explore all the possible treatments, managements and prevention’s. For many breasts get larger with age.

Remember, support from family and friends, support from good bra’s, diet to avoid weight gain.

Skin care is very important. Physical therapy can help with neck pain and posture.

Medication needs careful consideration. Some medication can contribute to size increase.

Hydroxyprogesterone can be used as a contraceptive and to limit breast size.

Prolactin (Bromocryptine) is a pituitary hormone that can be useful for some patients and cause problems for others.

Tamoxifen is an estrogen blocker which will be useful if your estrogen levels are on the higher side of average.

Danazol is used for fibrocystic breasts and may be useful if you have significant breast pain (Mastalgia)

Iatrogenic Gigantomastia

Breast enlargement might be a side effect of certain prescription drugs — such as hormone therapy (estrogen), birth control pills and certain antidepressants.

Idiopathic Gigantomastia

This group covers all those for whom we cannot find a cause. It is the most common group.

Future breast feeding and pregnancies.

These require forward planning. Do you want more children? Future pregnancies and breast feeding is possible but they come with a cost. That cost can be minimized with careful planning. You will need help from your gynae or endocrinologist to plan this out.

Liposuction remains the least invasive surgery. A CT scan will help with this decision. Breast feeding will still be possible afterwards. If the glandular component of your breasts is large Vaser liposuction will give a good reduction.

Liposuction of Large Breasts vs Surgical Breast Reduction

In the photographs above fat has been removed to make the breasts smaller. The patient on the left wanted to maintain some size but be free of symptoms. This was achieved. The patient on the right wanted everything gone. She has a 70% reduction in weight and is symptom free. The patient in the middle achieved a 6cm lift as measured from the scar on her abdomen. Unfortunately 10 years later her breasts started to grow again. She may need more treatment.

Is Reduction of Large Breasts Permanent?

Gigantomastia can be recurrent. Liposuction and surgical reduction can be repeated. It is easier to repeat liposuction than it is to repeat surgical excision.

In some cases breast removal (Mastectomy) is a valid option.