In the female world, breasts hold a very high position. It is a matter of self-esteem. Millions of women spend a lot of their time and money to ensure that their breasts are tantalizing. They invest in good bras, skin tightening creams, and exercises to keep their breasts in good shape. On the other hand, while breasts can give a boost to a woman’s confidence, it can also be a source of insecurity for some. Breast size and shape can become a matter of shame and can have a negative impact on their mental and even physical well-being. Macromastia is one such thing, it causes breast enlargement, which may be disproportional to the body. While some women spend billions to get larger breasts, it may come as surprising for some that others struggle with large breasts. We will further discuss Macromastia, what the disease is and the challenges it poses.
Due to extreme cases of obesity showing up in the current times, it is possible to mistake macromastia to be regular breast hypertrophy. Thus, it is important to be aware of macromastia. This knowledge may help in early diagnosis so that medical aid can be promptly provided to the sufferer.
It should be noted that breast hypertrophy also occurs in men and it is known as gynaecomastia.
What is Macromastia?
Macromastia is a rare medical condition in which the connective tissues present in the breast elongate and become excessively large. It is also known by another name, which is gigantomastia. There is negligible difference between Macromastia and Gigantomastia and these terms are often used interchangeably. The differentiating factor usually is the severity of the breast hypertrophy.
When the breast tissues weigh over 1.5 kilograms (or 3.3 pounds) but less than 2.5 kilograms (or 5.5 pounds) then it is said to be Macromastia. When the mass of the breasts exceed 2.5 kilograms (or 5.5 pounds) then it is said to be Gigantomastia.
All in all, macromastia and gigantomastia is excessive growth of breast tissues and come under breast hypertrophy. The exponential growth of the breasts can be unilateral (growth in just one organ of the body) or bilateral (growth occurs both the organs simultaneously). Breasts affected by macromastia are made up of adipose and fibrous tissues, and the presence of glandular tissue is stable.
Etymology and History of Macromastia
The terms Macromastia and Gigantomastia are both having Greek origins. Thus, it may be traced back to the Greek civilisation, where it may have been first observed.
Macromastia is derived from the Greek words ‘Macro,’ which means large, and ‘mastos,’ which means breasts.
Similarly, gigantomastia is derived from the Greek words ‘gigantikos,’ which means giant, and ‘mastos,’ which again mean breasts.
Thus, the terms clearly indicate that excessive growth of breasts can be attributed to macromastia or gigantomastia.
The earliest reported case of Macromastia dates back to 1670. The patient was a 23 or 24 year old woman and was diagnosed by Durston. The lady passed away after 4 months due to the rapid growth of the breasts from the beginning of the symptoms of macromastia. After her death, when one breast was removed and it weighed 29 kilograms (64 pounds)!
The most well-known case of the past was that of Lu-Shi, a 42 year old Chinese woman, who had macromastia. She was diagnosed in 1848 and went under the knife in 1849. She was operated on by a Chinese physician belonging to a missionary. The operation was carried out on only the left breast and lasted 3.5 hours. An excess of 2.7 kilograms (6 pounds) was removed. In the second sitting, which was a month later, her left breast underwent surgery. The extra mass weighed 2.5 kilograms (5.5 pounds). It was the first case that has undergone successful surgical operation.
The worst case of macromastia in the recent times was that from Ilorin, Nigeria. In 2007, a 26 year old woman approached Dr Ganiyu Adebisi Rahman and his colleagues for the immense swelling in her breasts. The bilateral axillary swelling had lasted for over 6 years. After intensive surgery, the excess mass that was removed weighed 44.8 kilograms (98.77 pounds)!
There have been many recurring cases of macromastia that keep cropping up all over. Macromastia, a disease that once was an unknown entity, was soon widely covered over media and news. Hence, there is a greater amount of awareness now available.
Types of Macromastia
The following are the different forms and types of macromastia:
Virginal (or Juvenile) Breast Macromastia:
This is when the conditions of macromastia develop during the puberty of the girl. It is also known as juvenile macromastia or juvenile gigantomastia. Other names include virginal breast hypertrophy and virginal mammary hypertrophy. In this form of macromastia, the growth and development of breasts begin at the onset of puberty and continue in a steadfast manner.
Juvenile macromastia may exhibit other symptoms too apart from excessive breast size. These include, redness, itching, soreness of breasts, pain in the breasts, and in severe cases lesions that can possibly bleed or get infected. Ulcerations may also develop around the region where the breasts are connected to the torso.
Usually, breasts begin developing at the beginning of puberty. There is a marked and rapid development of breast growth after the first menstruation (menarche), but if this arrival of puberty and breast development may indicate macromastia if there is a great amount of weight gain in the breasts.
It is difficult to set a universal standard for macromastia for young and maturing women especially since some exhibit a sudden and rapid growth in breasts, while for others, it may be a slow yet steady process. At the same time, some adolescents, who may have negligible breast growth, can have a sudden spurt in a very short span of time but it is hard to ascertain if it is just regular growth or macromastia. Thus, there is no benchmark against which this can be calculated. Although, medical experts presume that conditions in which an adolescent has shown regular and sustained growth, which was first slow and then followed by a rapid growth over a duration of minimum 6 months or more.
Generally, those suffering from macromastia may suddenly grow more than even three cup sizes within a period of a few days!
Women who have virginal breast macromastia also tend to have an enlarged clitoris.
Gestational (or Gravid) Breast Macromastia:
In adult women, macromastia may begin developing from the moment of conceiving a child, that is, the onset of pregnancy or even between the 16th or 20th week of gestation period. Often breastfeeding is also capable of triggering macromastia. This disorder may adversely affect the milk production in the mother’s breasts. Macromastia in adult women is accompanied with extreme swelling of the connective tissues. It is also observed that after each subsequent pregnancy, there is an increase in the swelling as well.
The rapid growth in the breasts of a pregnant woman can be an unpleasant experience. The growth may cause intense heat generation in the breasts, which may make them feverish and itchy. The breasts are usually red and raw and the skin is capable of peeling off the breasts. In extreme cases, necrosis, that is, the death of tissues, can also occur in the breasts. The swelling caused by the gestational breast macromastia may suppress the milk supply while feeding the baby. The milk ducts can be choked up due to the swelling presence in the surrounding areas and this may even lead to mastisis.
Gestational breast macromastia is a very rare phenomenon. In fact, so far there have only been 100 reported cases of gestational breast macromastia in the entire medical literature. The probability of spotting a case of gestational macromastia is 1 out of every 100,000 pregnancies around the world.
This is the rarest of the rare cases, but they cannot be ruled out either. Infantile Macromastia is when there is an enlarged breast development in infants or toddlers. The asymmetry present in this form of macromastia is far more pronounced.
Symptoms of Macromastia
Macromastia is usually an asymptomatic disease, that is, there are no tangible symptoms of macromastia. Different forms of macromastia can exhibit different symptoms (as given below). But by mere observation of the growth and development of breasts can indicate the commencement of macromastia. Generally, if the breasts grow and have a weight greater than about 3% of the body weight, it means it can possibly be macromastia.
Along with the uncontrolled growth, another observable symptom is the asymmetry present between the pair. Generally, one breast grows larger than the other, giving them a very skewed appearance. This asymmetry can also be seen in the nipples or the areolar region.
What can be perceived as a symptom of Macromastia could be the growth of heavy, large, and pendulous breasts. It may be accompanied with widened areolas.
Basically, since the core identity of the disorder lies around the fact that it is “excessive” growth of breast tissues without a clinical description of ‘excessive’, it becomes an extremely vague and ambiguous term.
Causes of Macromastia
Unfortunately, the field of medicine is yet to understand why macromastia occurs. Nonetheless, there are many hypotheses floating around that may try to explain the cause behind macromastia.
One theory suggests that macromastia may be due to the hypersensitivity of the end-organs. Due to this hypersensitivity, even normal level of sex hormones may still perpetuate the growth of secondary sexual characteristics even though development should stop.
Another theory postulates that it could be due to the excessive secretion of these sex hormones especially during adolescence. Due to the high concentrations of hormones, there is a high hormonal activity, which may lead to macromastia.
However, the second pathogenesis gets refuted since on further research it was observed that some participants showed regular levels of hormones like oestrogen, progesterone, prolactin, growth hormones and gonadotropins. Nevertheless, these mainly known theories have propped the medications that are administered to control macromastia.
What health experts have observed is the correlation or juvenile macromastia with Cowden syndrome. Hence, those who have a medical history of Cowden syndrome have greater chances of developing macromastia too. Cowden syndrome is a rare genetic disorder in which the autosomes undergo mutation of the gene called PTEN (phosphate and tensin homologue) which is known to suppress tumour formation and is located on the long arm of the 10th chromosome. Thus, family generations who have been afflicted with Cowden syndrome should also be mindful of the risks of macromastia.
There has been a trend that has been noticed that relates macromastia to even certain drugs like penicillamine, indinavir, ciclosporin, buccilamine, and neothetazone. Almost 50% of the female population who suffer from aromatase excess syndrome, which is a condition of hyperoestrogenism, also develop macromastia. Macromastia is also linked to hypercalcemia, which is the excessive production of a protein related to parathyroid hormone.
The leading cause of breast hypertrophy in the present era is also due to the sudden rise in obesity. Approximately 2/3rds of women who have macromastia are also obese. We are consuming high fat, high sugar foods that are loaded with hormones. This can be a contributing factor to the rising cases of macromastia.
Diagnosis and Treatment of Macromastia
Before beginning any procedure, a comprehensive medical, psychological, and surgical history is obtained from the patient. After that, markers like height, weight, etc. are recorded to measure the body mass index (BMI).
If the case is of juvenile macromastia, then relevant details like the pubertal growth and the commencement of menarche is recorded. For gestational macromastia, essential details pertaining to the pregnancy and delivery are noted down.
After updating all the information, the breast growth velocity and the stability periods are observed. Additionally, tests are run to ensure that there is no presence of tumours or any masses. Any breast or breast wall deformity is also investigated. Another characteristic that is detected is whether the enlargement of the breast is unilateral or bilateral. Family history is probed into, especially related to breast hypertrophy or breast cancer.
The breasts are examined for lumps or any irregular masses. Special care is given to the assessment of the skin quality. Striations and intertrigo are spotted out, if visible. If there are mass lesions present, then an ultrasonography or MRI scan may be recommended for safety purpose.
Under normal circumstances, the physician will prescribe hormonal therapy to counter macromastia. It largely includes administration of progesterone, bromocriptine, tamoxifen, testosterone, and the gonadotropin releasing hormone agoinst leuprolide. These drugs have been proven effective against certain cases of macromastia. Unfortunately, it is not entirely necessary that it may be effective on all cases. Danazol is an anti-oestrogen and a weak androgen, it is also employed to treat macromastia.
These breast reduction pharmaceutical steroids can single-handedly tackle instances of gestational macromastia. Although they may not reduce breast size or alleviate the symptoms, they arrest the development of the breasts.
Home Remedies for Macromastia
So far, we have understood that Macromastia is caused due to the body’s hypersensitivity to even regular production of oestrogen. Therefore, the best way to combat is through stabilising the hormonal imbalance. Ways to do this through the following herbs and including them using the home remedies:
1. Flax Seeds:
Flax seeds (Alsi seeds) are rich in Omega 3 Fatty Acid. These magic seeds are capable of reducing the oestrogen levels in the body, and will contribute significantly in reducing the effects of Macromastia. You can mix the powder of flax seeds in regular flour to get multigrain flour and consume flax seeds on a daily basis.
Make a powder of Flax seeds and store in a dry, airtight container. Mix and stir the powder in a glass of warm water, drink it once a day. Continue this daily.
Ginger (Adrak) has fat burning properties and therefore can cut down the fatty tissues in the breasts. It also aids metabolism, which will in turn help to reduce breast size.
Grate some fresh ginger and add it to a glass of water. Boil this water for 5-10 minutes. Strain the extract and drink the mixture twice a day on a daily basis.
3. Camellia Sinensis:
Camellia Sinensis is the scientific name of a type of Green Tea. It is specifically used for medicinal purpose. It is known to reduce fat build-up.
Boil a cup of water and add a teaspoon of Camellia Sinensis. Cover it and allow it to brew for 3 minutes. You may add half a teaspoon of Honey for taste. You can have this concoction thrice a day daily.
4. Azadirachta indica:
Azadirachta indica (Neem) is known to have a lot of medicinal properties. It is capable of controlling effects of Macromastia too.
Boil 6-7 Neem leaves in 4 cups of water for about 10-15 minutes. Strain the extract. Add 2 teaspoons of Turmeric and half a teaspoon of Honey to the decoction. Stir it all together and consume this once on a daily basis.
5. Egg Whites & Onions:
Egg whites help in the reduction of the breast size, while onions tone down the breast muscles and can help relieve the pain associated with Macromastia.
Separate the yolk from the egg whites. Beat the whites until it has a smooth and creamy texture. Apply this mixture at the base of your breasts and leave it for 30 minutes. Squeeze out the juice from the onion and dilute it with a glass of water. Wash off the egg mixture using the onion liquid. Allow the onion mixture to remain on the skin for 15 minutes. Rinse it off with regular water. Continue this procedure for about 2-3 times in every week.
Also Read: How to Reduce Breast Size Naturally
Role of Society and Culture
Society and culture make women with macromastia uncomfortable. Usually, large breasts tend to form the focus of one’s attention. Therefore, women try to hide their breasts using specialised clothing items like minimising bras. In fact, women with large breast sizes also find it difficult to find bras and other intimate wear items in their preferred size. Large size bras are costlier and may not be well-fitting or comfortable.
The reception by the society is usually apathetic, wherein people do not think of large breasts as a problem. Rather, it gets associated as a virtue. Thus, there is next to no support system available for women suffering with macromastia.
We will further discuss the effects and challenges of Macromastia in the following section.
Effects of Macromastia
Macromastia has lasting effects on the health and mental well-being of those suffering from this disorder. Women have to face a lot of physical and psychological baggage due to the condition. Some of them are briefly discussed below:
Mastalgia, otherwise known as mammalgia or mastodynia, is commonly present in those suffering from macromastia. It involves a dull or throbbing pain in the breasts, burning sensation in the breast tissues, breast tenderness or soreness, heaviness, and tightness. This pain usually emanates from the upper breasts and is present in the outer area. In certain cases, the pain may also seep into the arms and the upper torso. This pain can be cyclic (that is, occurring periodically) or acyclic (that is, occurring randomly)
Neck, Shoulder and Back Pain:
The excessive weight of the breasts put a stress on key areas like the neck, shoulder, and the back. In fact, women with macromastia often complain of headaches and pain originating from the upper or lower back. Knots develop in the shoulder causing muscular stress and stiffness. This pain in the shoulder may even branch out into the arms and cause numbness or a tingling sensation in the fingers (Ulnar paraesthesia: see below). The pain can be dull and persistent or sharp and stabbing.
Many patients even complain of having developed Cervical Arthritis due to the constant pain.
Needless to say, the extra weight also causes problems in maintaining a proper posture. Incorrect posture significantly contributes towards back pain, further intensifying the ordeal. Women are capable of developing a hunchback due to the constant forward pull. The back gets curved excessively, which is known as kyphosis. Being in the hunchback position also causes chest tightening, thereby worsening the mastalgia. The thoracic spine (upper back) comes under stress which leads to the weakening or the loosening of the postural muscles. Not just the back region, but the neck also gets vastly affected. Macromastia can give rise to forward head, a condition in which the head is tilted towards the front.
Sub Mammary Maceration
Sub mammary maceration is the wetness and softness of the lower mammary section. Maceration occurs when the skin is exposed to moisture for a prolonged duration and it results in breaking down of the skin. Perspiration occurs in large amounts in hot and warm weather conditions. The sweating in the region below the breasts causes skin rashes and deterioration of the skin. Not just limited to sweating, the body also loses fluids by the process of Trans Epidermal Water Loss (TEWL) which breaks down the skin below the breasts.
In extreme cases skin maceration can develop into ulcers.
In continuation with sub mammary maceration, another affliction is intertrigo occurring in the sub mammary region. Intertrigo appears as red and raw looking rashes that could be itchy and ooze exudates. It causes inflammation of the skin and when coupled with maceration, it may even result in fissuring (cracking) and peeling of the skin. Sweat that gets trapped between the folds of the skin is unable to evaporate. This moisture is what leads to intertrigo and maceration. Often, this rash becomes a rich spot for fungal growth. Once the skin breaks out, the inflammation becomes a site fungal intertrigo. Frequent manifestation of the intertrigo is known as candida intertrigo. Often, the body continues to relapse and develop intertrigo. If not given proper medical attention, the sub mammary intertrigo can lead to peripheral scaling of the skin.
Basically, the stress on the shoulders due to large breasts adds pressure to the arms and wrists as well, and especially the elbow. This path is along the route of the ulnar nerve present in the arms. Thus, the region from the shoulder to the elbow can experience regular pain. In the lower limbs, one can feel numbness in the fourth and the fifth digits of the hand. It is extremely hard to notice these symptoms. Sometimes, even the third digit gets affected. In some cases, the numbness is replaces with a tingling sensation. It is very rare that the lower arm experiences any pain.
Apart from just the arms, there is a possibility of other sensory symptoms that reflect in the limbs.
Indenting of the Shoulder
If finding the right sized bra is not enough of a challenge, then the indentation of the shoulders due to the bra is even worse. Narrow bra straps cut into the skin and can even cause redness, itchiness, and chronic irritation. The shoulders are indented by the bra straps are more prone to shoulder pain. The straps digging into the shoulders are capable of nerve damage. The grooving of the shoulder causes great irritation.
Skin hyperaemia occurs due to the growth spurt occurring in the breasts. Hyperaemia is the overflow of the blood vessels into an organ, here the organ are the breasts. The congestion of blood in the skin causes redness (erythema) and overheating of the skin. Usually, it is a body response to dissipate body heat to the external environment, but localised skin hyperaemia, especially in the breasts make it extremely uncomfortable for the sufferer.
Along with the signs of skin hyperaemia, one can also notice the dilation of the subcutaneous veins. It makes the veins in the breasts look like a stark contrast and makes them stand out.
Skin necrosis is the death of skin tissues. Sometimes, the death could also be premature. Albeit skin necrosis is not extremely common, but it is highly possible in those women showing a great velocity in breast growth during macromastia.
Women, especially adolescent teenage girls suffer great adverse effects of macromastia. It acts as a hindrance to their emotional development. For girls entering maturity, it can be a distressing time accommodating and adjusting to the new bodily changes. They find is exceptionally hard to take on adult responsibilities and sustain human relationships. The budding awareness of the human sexuality can tip their emotional stability.
The adolescent may develop body image issues and undue social ostracism. They may even attract bullies or lewd comments. Thus, they will end up having low self-esteem. This may even lead to eating disorders.
Due to their breasts being the constant focus of attention, it may attract nasty remarks and they may be unable to seek out social acceptance. Moreover, low self-esteem can cause depression in not just in youngsters but also in adults. It is worse in teenage patients because they have no outlet for the distressing emotions. They may be unable to indulge in physical activities, like running or sports, and even shut out from social interactions. Thus their depression may turn more severe and they may be unable to find any help.
Reduction Mammoplasty: Is it the right choice for you?
Reduction Mammoplasty (also known as mammoplasty or mastoplasty) is a multi-part surgery to reduce breast size. It is the widely accepted treatment offered to those suffering from juvenile macromastia, although it is not mandatory to undergo this surgery. Gestational macromastia, as mentioned before, can generally be dealt with through the hormonal therapy. Since hormonal therapy may have negative effects on an adolescent, it is generally avoided for juvenile macromastia. Hence, mammoplasty is an effective method.
But not everyone undergo the surgery. The ideal candidate who can undergo the surgery should:
- Have skeletal maturity
- Not smoke
- Not have any physical or psychological health contraindications
- Have at least 1.8 kilogram (4 pounds) of breast tissue that need to be removed
Patients willing to undergo mammoplasty may be evaluated by psychologists to assess if they suffer from any psychological issue or eating disorders. Counsellors are also made available to help patients prepare psychologically. Nutritionists may outline a diet that will aid them in losing weight. Most obese patients will first have to shed a lot of weight before they begin mammoplasty.
After the patient suits all the requirements of being the perfect candidate for mammoplasty, multiple surgeries are conducted upon them. The number of operations that need to be conducted depend upon the severity of the macromastia. The mammoplasty is carefully planned keeping a lot of factors in mind and it may not be as immediate as the sufferer may want it to be.
Once a single operation from the set of surgeries is over, breast growth stability is observed. It is possible that the breasts may grow back in the postoperative phase. Thus, it may even affect the total number of operations required. Additional procedures may be required.
Very mild hormones in minute quantities can be administered after the operations to inhibit the breast growth. If the patient’s breasts continue to regrow, then as a last resort, mastectomy is conducted on the breasts.
It has been observed that patients feel relieved after the surgeries and are extremely satisfied throughout their teenage and even adulthood. They can assume normalcy and again reintegrate back in the society.
Macromastia is capable of altering a person’s self-perception and body image. Thus, it is important to spot it right at the very beginning. It is especially very alarming for young girls and even more emotionally distressful in their development stages. At the same time, one cannot rule out the anguish an adult with macromastia feels. The suffering gets compounded by the negative implications it has during breastfeeding. Macromastia is an issue that troubles women of all age groups and can negatively impact their lives. A rarer form of macromastia is infantile macromastia, where a few months old babies can also develop enlarged breasts.
Not just psychologically, but macromastia also affects the physical well-being. It gives rise to a number of health complications due to which a person cannot live a healthy, carefree life. It inhibits social interactions and sporting activities.
There are many herbal home remedies available. As for the medicinal treatment, it is mostly a hit or miss situation. Gestational macromastia may be treated with the introduction of synthetic hormones, while cases of juvenile macromastia are referred for breast reduction mammoplasty. Those suffering from obesity have to mandatorily lose weight before the surgery procedure begins. After the train of operations, hormones may be given to retard the breast growth.
If you exhibit signs of rapid breast growth, please see a trusted physician immediately for further guidance. The size of your breasts is nothing to be ashamed of and you should seek immediate medical assistance. You could be avoiding a great amount of mental trauma and health complications that follow macromastia.
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