The breast is linked to the image of the woman, of motherhood, and any deformation or disease has both physical and psychological repercussions. Gestational gigantomastia, a rare and poorly understood pathology, whose incidence is estimated at around 1 per 100,000 births, is nonetheless disabling [1] with permanent bed rest, painful ulcerations, skin necrosis, and hemorrhages. It can be life-threatening due to septic shock. Caucasian women seem to be more affected than African-American women [1] [2].

This pathology appears most often in the first half of pregnancy [3]. Few cases have been reported in black women. Its etiopathogeny remains poorly elucidated and is thought to be related to hormonal phenomena in ill-defined mastopathy terrains [1]. Gestational gigantomastia poses a problem for therapeutic management. Medical, surgical, and obstetric treatments have been instituted on a case-by-case basis [1] [3] [4].

Gestational gigantomastia is a rare and mostly unknown entity.

We report a rare case of bilateral gravidic gigantomastia in order to discuss the diagnostic and prognostic aspects and etiopathogenic problems in black women. The compromise of the breastfeeding function is related either to the pathology itself or to the surgical technique used.

This is a 31-year-old black female patient, fourth gesture with 3 healthy living children and no particular pathological history. Pregnant at 25 weeks of amenorrhea, she was seen for bilateral and painful breast enlargement that appeared during the first trimester of pregnancy.

On admission, we found: a blood pressure of 100/70 mm Hg, a tachycardia of 120 beats per minute, a temperature of 36˚5, a weight of 70 kilograms for a height of 157 cm (body mass index equal to 28.5 kg/m²).

The breasts are voluminous, rounded with a shiny pitted skin, ulcerated and budding zones. They measured 37 cm in length by 34 cm at the base for the right breast and 34 cm by 33 cm at the base for the left breast (Figure 1). The obstetrical examination was unremarkable.

The haemogram showed an anaemia of 8.7 g/dl microcytic, leukocytes of 12 G/l (normal value during pregnancy) and a normal platelet count.

On breast ultrasound, the right breast showed significant thickening of the infiltrated breast connective tissue with hyper vascularization and fibroglandular collection and on the left breast there was significant thickening of the glandular breast connective tissue.

Pathological examination after microbiopsy showed bilateral fibrocystic mastopathy (Figure 2).

The obstetrical ultrasound scan showed an evolving intrauterine monofetal pregnancy whose biometry corresponded to 25 weeks of amenorrhea.

We then instituted a treatment protocol based on local antiseptic care, cabergoline 0.5 mg per week, a level 2 analgesic and martial supplementation.

After 10 days of treatment we noted a worsening of her condition with a systemic inflammatory response syndrome, bilateral mammary fleshy budding (Figure 3), necrosis, abscessation, anemia at 7 g/dl and a biological inflammatory syndrome. She then received broad-spectrum probabilistic antibiotic therapy in addition to the treatment received above and a decision was made to terminate the pregnancy.

After blood transfusion, attempts to induce labor were unsuccessful, and a female neonate weighing 1200 grams with an Apgar score of 7/10 at the first minute was extracted by cesarean section. The immediate postpartum period was simple.

However, at 7 days postpartum, we noted a deterioration in her general condition with dehydration and malnutrition. The patient weighed only 50 kg.

The breasts were tense, painful, ulcero-necrotic-hemorrhagic, suppurated with monstrous dilatation of the mammary veins. They measure 39 cm by 30 cm (Figure 4).

A semi-emergency bilateral mastectomy was then performed with simple immediate postoperative care. The operative parts each weighed 8 kg (Figure 5).

The skin suture was done under tension on the left side, which led to a fall of eschar. Directed healing (detersion, budding and epidermalization) went well (Figure 6).

The breast is not involved in reproductive function, but it is associated with the image of femininity and motherhood (breastfeeding). Gestational gigantomastia is a rare, non-cancerous but highly disabling condition that can be life-threatening for pregnant women in certain situations, thus requiring radical treatment (total mastectomy).

The authors have declared that they have no conflicts of interest.

Rahadat, I., Niassy, A.C., Sarr, I.S., Sankharé, A., Dede, M.Y., Dia, A.N., Diallo, M., Faye, M.E. and Moreau, J.C. (2022) Bilateral Gravidic Gigantomastia at the Gynecological and Obstetrical Clinic of Dantec: A Case Report. Open Journal of Obstetrics and Gynecology, 12, 993-998. https://doi.org/10.4236/ojog.2022.129082