Juvenile gigantomastia is a rare benign breast condition. Its incidence is very low, especially in the Caucasian population. In the literature, it is most often reported as case studies [2] [6] [10] . In our context, this rarity may be understated due to a lack of awareness of the condition in our areas.

A few cases have been reported in Africa: 3 cases in Côte d’Ivoire in 2010 and 2023, and 1 case of gestational gigantomastia in Senegal in 2015 [14] . There is no universal classification or validated definition of this condition.

No etiology has been identified in our context due to inadequate technical resources. However, recent studies highlight the significant role of ERα and aromatase in juvenile gigantomastia [2] [7] [8] . ERα increases tissue sensitivity to estrogens and aromatase, thereby promoting local tissue production. The absence of ERα is believed to be responsible for this condition. Other authors have mentioned autoimmune diseases among other factors, due to hormonal influences [15] . The investigation into the involvement of growth factors appears justified due to stromal hyperplasia noted in histology. Thus, cases of gigantomastia have been found in patients who have undergone liver transplantation for alpha-1 antitrypsin deficiency, thyrotoxicosis [1] , systemic lupus erythematosus [16] , and congenital anonychia [17] .

The signs that often lead parents to seek a consultation vary and are marked by: a very rapid increase in breast volume becoming unaesthetic for the minor, scapular pain, and postural disorders of the spine [10] . In our case, the consultation delay was 3 years, indicating a delay in seeking medical attention in our environment. This delay is explained by the parents’ ignorance, lack of financial resources for care due to the absence of health insurance.

Diagnosis is primarily clinical, characterized by a breast weighing 1500 g or more, compared to a normal breast with an average weight of 300 g [11] . It is predominantly bilateral with an inflammatory appearance, skin thickening, and engorgement of breast veins.

Imaging is not very contributive and is often laborious due to the breast volume. It shows edematous thickening of the cutaneous and glandular structures [18] [19] . It helps to characterize or detect associated lesions.

Hormonal assessments often show a variable increase in prolactin levels not linked to a pituitary abnormality. This assessment was not conducted in our context due to financial constraints.

Histologically, juvenile gigantomastia is marked by florid stratified epithelial proliferation with papillary structures, without atypia, and vacuolated epithelial cells indicating significant secretory activity. In the stroma, edema, sclerosis, and necrosis are found. The exaggerated appearance in this context should not overshadow the possibility of other rare breast pathologies like breast lymphomas [19] . In our context, we initially performed a micro-biopsy with histological examination confirmed on surgical specimens. It was a proliferation with both fibrous and adenomatous components, with no signs of malignancy. Similar results have been reported in the literature [1] [5] .

Medical evaluation aimed at aiding therapeutic decision-making highlighted the difficulties she faces in daily life (unaesthetic appearance, spinal postural disorders, psychological burden related to judgments from those around her).

In our case, medically, the patient experienced spinal pain and difficulty walking due to kyphosis and the weight of her breasts. Psychologically, she faced stigma at school and was often mistaken for being pregnant by her peers. Her health condition exempted her from sports activities.

The management was primarily medical through supportive psychotherapy in our case, followed by surgical intervention via breast reduction, as reported in several studies [20] [21] .

In the literature, there is a discrepancy in the weight of the reduction, ranging from 0.8 to 2 kg. Three main techniques are described according to Loury et al. [22] [23] : the areolar graft amputation described by Thorek, the superior dermal-glandular pedicle, and the inferior dermal-glandular pedicle. For the latter two techniques, the advantage lies in preserving the areola-nipple complex (ANC), with significant risks of necrosis. To apply these techniques to major hypertrophies and gigantomastias, the sterno-nipple distance must be less than 35 cm [B], and the pedicle carrying the nipple should be broad, adhering to the principle of a random flap (L/l < 2) [1] .

In our context, the superior pedicle technique was used based on preoperative evaluation. The risk with this technique is necrosis of the areola-nipple complex, as noted as a complication in this context, with more or less complete closure. A graft of the nipples from the genitocrural folds would be an alternative. Some authors sometimes opt for tattooing. This option is possible in our context, but the risk of keloids is often high in the black race.

In our context, we opted for the graft. The lack of financial means for treatment and the absence of health coverage explain the delay in her care.

The literature indicates that there is no ideal technique for correcting breast hypertrophy and ptosis. The choice of technique is adapted to the preoperative situation: techniques with a periareolar scar allow for the correction of small ptosis (2 to 3 cm), possibly combined with the placement of an augmentation prosthesis; hypertrophies require the use of a superior pedicle technique, leaving a vertical scar or an “anchor” with a short horizontal branch; large hypertrophies necessitate the use of inferior pedicle techniques or even a free areolar graft. It is essential that these techniques, with their advantages and disadvantages, are discussed with the patient before the operation. Under these conditions, the correction of breast hypertrophy remains a procedure that satisfies the majority of patients [21] [23] .

In our context, the outcomes of the treatment were satisfactory compared to her previous state, according to her. She was very pleased with the comfort, femininity, and psychological well-being achieved. Nevertheless, addressing the complications would further enhance her physical, mental, and psychological well-being.

Recurrences are possible. To address this issue, some teams have attempted medical treatment with Tamoxifen. Baker et al. [22] suggest that Tamoxifen could be a useful adjuvant treatment to help maintain stable results. In our context, there have been no recurrences after 6 months to a year of medical follow-up without hormonal treatment.