A 23-year-old woman from Middle East, in the prime of her youth, was in great distress because of her giant breast size which was induced due to her pregnancy. Due to a rare condition, her breasts had grown extremely large in size, weighing as much as 11 kgs and were reaching down to her knees. She could barely stand for more than five minutes and hardly venture out of her house. After suffering from the condition for 7 months, she finally got the big burden off her chest when she got successfully operated upon by a team of specialists at Amrita Hospital, Faridabad, in a surgery that lasted ten hours.

The patient (name withheld on request) was suffering from bilateral gestational gigantomastia, a rare condition during pregnancy that leads to development of extremely large breasts due to excessive and disproportionate breast tissue growth. Her breasts had elongated with excessive weight, reaching down from her chest to below the knee. The woman was facing severe physical, social, and emotional disability. Walking was extremely difficult, and she could not do day-to-day chores.

The patient had been to several hospitals in her own country and elsewhere in India but was told she would need amputation of the breast and then separate reconstruction with breast implants at later date. She was also told there was an extremely high risk of excessive bleeding and danger to her life during the surgery. The woman then visited Amrita Hospital in Faridabad.

Said Dr. Mohit Sharma, Head – Plastic & Reconstructive Surgery, Amrita Hospital, Faridabad: “The patient came to us with extremely large breasts. She had a history of three abortions in previous years. She suffered from bilateral gestational gigantomastia during her third pregnancy, which also ended in spontaneous abortion at 22 weeks of gestation. The woman started developing extreme breast enlargement during this period and came to us after suffering from the condition for many months. Surgery in this case was very challenging and required a multidisciplinary team approach to optimise outcomes.”

According to the doctor, it was an intricate, one-of-a-kind case where the entire breast tissue of the woman was hanging down from her chest to just below her knees. The surgeons led by Dr. Mohit Sharma decided to opt for a mastectomy and free nipple grafts where the nipples are completely removed from the breast and replaced as a skin graft. Other types of breast reduction surgeries would not have worked in this case, as maintaining the blood supply to nipple and areola would not have been possible. The doctors went ahead with mastectomy and took the nipple-and-areola complex as a separate, full-thickness graft on top of the reduced breast.

Sharing details of the surgery, Dr. Mohit Sharma said: “We came up with an innovative plan in which we used the skin flaps of the large breasts as fillers to maintain the breast volume. So, the breast was amputated in a particular fashion, and the excess skin flap and fat were derived from the remaining tissue. The skin was removed from the outer and inner flaps, and then we folded the tissue flap to maintain the volume inside the breast envelope. After stopping the bleeding with a special harmonic scalpel, we closed the breast in a meticulous fashion after inserting some drains to take out the excess blood and secretions.”

He added: “We then placed a nipple-and-areola graft on a pre-marked site, secured it with a special glue, and covered it with a dressing to allow for full healing after grafting. This case was particularly complex as it was very difficult to stop bleeding and create a normal-looking breast. However, with our planning and a two-team approach, we could minimize the blood loss and achieve a result that was satisfactory to the patient.”

The procedure and post-surgical recovery of the patient went well, and she can now walk and move freely without any restrictions. As a treatment modality, she may require additional correction later, said the doctor. The surgery was performed by Dr. Mohit Sharma along with three other surgeons from Amrita Hospital, Faridabad, including Senior Consultant, Dr. Anil Murarka, Dr. Vasundhra Jain and Dr. Neha Suri.

Said the woman after the surgery: “I am very happy with the results of the surgery and now I again look like how I used to look earlier. I look forward to leading a normal life once more. I thank the doctors of Amrita Hospital for attempting this surgery and making it a success.”