Gestational Gigantomastia in Multiparity: Successful Management with Bilateral Reduction and Free Nipple Grafts

BACKGROUND Gestational gigantomastia is a rare but benign diffuse enlargement of one or both breasts during pregnancy. This report describes the case of a 36-year-old woman with a history of previous pregnancies who presented with back pain associated with bilateral massive breast enlargement that was managed with breast reduction surgery. CASE REPORT A 36-year-old woman, gravida 4 para 3+1, presented 6 months postpartum with significant bilateral breast enlargement, shoulder numbness, and back pain. She was not breastfeeding, and her symptoms began in the second trimester of her fourth pregnancy. There was no evidence of overlying skin changes. Breast length from the sternal notch to the nipple was measured on the right breast at 50 cm and the left at 52 cm. A multidisciplinary team was involved, and the patient underwent bilateral breast reduction with free nipple grafts. A total of 5.150 kg of right breast tissue was excised, measuring 38.0×32.0×8.0 cm. Similarly, 5.530 kg of left breast tissue was excised, measuring 36.0×30.0×9.0 cm, for a total of 10.68 kg of breast tissue. Histopathological investigation confirmed benign breast tissue with fibrocystic changes, with no signs of malignancy. Her postoperative recovery was uneventful, with complete resolution of musculoskeletal symptoms and satisfactory aesthetic outcomes. CONCLUSIONS Gestational gigantomastia requires a multidisciplinary approach. This case highlights its potential to occur in later pregnancies, even without prior history, and demonstrates that bilateral breast reduction with free nipple grafts can offer effective symptom relief and favorable cosmetic outcomes. Preoperative counseling and individualized treatment planning are essential to optimize patient outcomes.