Macromastia

Macromastia is an excessive growth of the breasts. Macromastia is a synonym for breast hypertrophy and gigantomastia.

Author:	Doctor Alejandro Querales
Reviewed by:	Ana Codallo, CTO
Last Updated on Aug 20, 2023

What Is the Criteria for the Diagnosis of Macromastia?

Another definition of Macromastia is: an excess weight of the breasts equivalent to or greater than 3% of the total body weight of the subject.

What Is Macromastia ICD 10 Code?

Macromastia's ICD-10-CM code is N62.

Macromastia is so rare that there are very few published studies about the condition. However, there is no specific cause for this type of growth. It can occur at different stages, such as the pubertal stage (puberty) and during pregnancy. In even fewer observed cases, it's due to the use of medications such as LH-RH hormone antagonists and anti-androgens. There are also cases due to genetic predisposition.

The amount of time it takes for this growth to occur may vary. Some cases are noticeable in a matter of years, but some women notice an increase in breast size in weeks.

The symptoms mainly include back pain (dorsalgia and lumbago) due to the same postural problem and mastalgia (breast pain). There are also medical reports of infections.

Among the most common treatments, we have surgical procedures done by surgeons specializing in cosmetic and reconstructive surgery. However, most cases resolve independently, and treatment is usually unnecessary.

What Are the Different Types of Macromastia?

There are five main recognized types of Macromastia:

• Juvenile macromastia: It happens in the pubertal stage (puberty).
• Gestational macromastia: Related to excessive breast growth during pregnancy.
• Drug-induced macromastia: occurs as a result of taking certain medications that can alter the feedback mechanisms of the hormonal axes and cycles. Other drugs reduce or suppress androgens, "male" hormones needed to maintain female health; these drugs that induce high levels of female and growth hormones, may cause macromastia.
• Idiopathic or primary macromastia: Meaning it has no obvious origin. It's the most frequent type of macromastia.
• Gigantomastia: Is also defined as an excessive breast growth but to fall under this category the excess tissue must have a weight of at least five pounds.

What Causes Macromastia?

The list of possible causes for macromastia is small, considering that primary or idiopathic macromastia is the leading one; that is, when there is no obvious suspected cause. Other causes may include:

• Extreme obesity
• Genetics
• Puberty
• Pregnancy
• Drugs, particularly LH-RH blockers, anti-androgens, and antibiotics such as penicillin and bucillamine
• Immunological: Diseases of the thyroid gland (Hashimoto's thyroiditis), systemic lupus erythematosus, myasthenia gravis, chronic arthritis, and psoriasis.

How Common Is Macromastia?

It's a rare condition, even for gynecologists and mastologists (sub-specialists in pathologies of the breasts). There are about 300 reported cases, and all have been benign (not cancerous).

Macromastia Symptoms

• The cardinal symptom is the excessive increase of the breasts that can be in one (unilateral) or, more frequently, in both (bilateral) of them.
• Mastalgia (breast pain)
• Dorsalgia, lower back pain, and possibly shoulder and neck pain due to the weight of the breasts that modifies the body's natural posture
• Bad posture
• Itching, temperature changes (heat), and redness
• Decreased sensitivity or loss of sensation in the nipples
• Infections and abscesses
• Lesions or infections under the breasts
• Painful lesions and stretch marks in the bra strap area

How Is Macromastia Diagnosed?

When consulting a medical doctor or specialist, the physician may ask about your medical history. The physician may ask questions to collect essential data, including the reasons for consultation, when the symptoms started, your previous clinical history, medications you take, and relatives with similar symptoms, particularly your mother, maternal and paternal grandmothers, and, in some cases, sisters and maternal and paternal aunts.

Next, the physician will likely perform a physical examination in which a breast examination will be necessary. If the diagnosis of macromastia is suspected, pertinent tests can be indicated, including a hormonal profile and imaging (ultrasound of both breasts or mammography).

Some characteristics used to diagnose macromastia include:

• The size of your breasts as well as the timeline and rate of growth.
• The date of your first menstruation to determine if there was precocious puberty.
• Possible pregnancy.
• Drugs or medications taken that may lead to suspicion of macromastia.

Macromastia: Treatment Options

Currently, there is no standardized treatment for macromastia. However, the first thing to consider is to rule out other pathologies that can range from infections and pregnancy to cases of malignancy in the breasts (breast cancer).

Surgery

After your doctor has ruled out any other pathology of macromastia, they may suggest or refer you to a specialist in plastic surgery (aesthetic-reconstructive) to perform what would be a reduction of the excessive size of the breasts (reductive mastectomy).

Medicines

• Bromocriptine: It might slow down or stop breast growth.
• Tamoxifen: Frequently used in breast cancer.
• Danazol: Common in endometriosis and fibrocystic breast disease.

Macromastia: Are There Complications?

Macromastia can cause infections and physical and psychological problems in women affected by this rare condition. Other possible complications:

• Breast asymmetry
• Tight and sensitive skin
• Loss of sensation in the nipples
• Difficulty breastfeeding
• Back, neck, and shoulder pain
• Postural problems
• Headaches
• Damage to the intercostal nerves (the cause of little or no nipple sensation)
• Difficulty practicing sports or exercising
• Anxiety
• Body dysmorphia
• Avoidance of social activities and isolation
• Depression
• Breast milk suppression
• Reduced fetal growth
• Spontaneous abortion
• Infections and breast abscesses
• Cracks, lesions, and stretch marks on the skin of the breasts

How Can I Reduce My Risk of Macromastia?

It's difficult to determine the cause of macromastia and even more challenging to prevent it. Since the leading cause is idiopathic and associated with genetic factors, more in-depth studies are usually required.

What Can I Expect if I Am Diagnosed With Macromastia?

Macromastia is a condition that causes discomfort and pain, both physically and mentally. Ideally, you should consult a physician as soon as the cardinal symptoms become noticeable. Your primary doctor is the ideal person to guide you in finding the best solution.

What Is the Prognosis for Macromastia Patients?

Macromastia requires treatment as soon as possible because it can cause breast pain, severe posture problems, and daily back pain that may incapacitate the patient.

Macromastia may affect mental and physical health, cause infections that may be difficult to treat, and cause problems during pregnancy and breastfeeding. Even though macromastia is benign, any other pathology that may increase breast volume must be ruled out, including breast cancer.

There are few registered cases of emergency mastectomies for macromastia; usually performed in cases where the spine is compromised. Generally, macromastia-related surgeries are elective surgeries.

Reductive mastectomy is the primary treatment course for macromastia in most cases. It's highly effective if plastic and reconstructive surgery specialists perform the procedure. During puberty, there is the possibility for recurrence of breast growth, so even though a mastectomy is possible, it might be advisable to wait; unless the volume of the breasts increases rapidly. Another situation in which plastic surgery may not be effective (or practical) is during pregnancy.

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