Gestational gigantomastia in the early postpartum period presenting with severe refractory pain: a case report.

Introduction: Gestational gigantomastia (GG) is a rare, benign breast disorder characterized by rapid, excessive, and disproportionate breast enlargement during pregnancy. Affected patients may develop severe breast pain, skin breakdown, secondary infection, and musculoskeletal complications, resulting in significant functional impairment and psychosocial distress. Case presentation: We report the case of a 24-year-old woman (G2P1A1) who presented on the second postpartum day with a 5-month history of rapidly progressive bilateral breast enlargement and severe, disabling breast pain of 2 days' duration. Despite treatment with bromocriptine and multimodal analgesia, her pain remained refractory, necessitating emergent bilateral simple mastectomy. Histopathological examination confirmed GG, and the patient had an uneventful postoperative recovery. Discussion: GG is an uncommon clinical entity, with an estimated incidence ranging from 1 in 28 000 to 1 in 100 000 pregnancies. Although hormonal hypersensitivity is presumed to play a role, its etiology remains poorly understood. Medical management is generally recommended as first-line therapy; however, complete regression is uncommon, and the clinical response is often limited. Consequently, surgical management remains the definitive treatment option in many cases, particularly when complications arise or conservative therapy fails. Conclusion: Early postpartum GG with severe refractory pain requiring emergent bilateral mastectomy is exceedingly rare. Bilateral mastectomy with planned reconstruction may be an appropriate definitive treatment option when conservative measures fail, particularly for patients wishing to reduce the risk of recurrence during future pregnancies. Furthermore, this approach avoids the potential risk of life-threatening hemorrhage associated with the alternative surgical option of reduction mammoplasty.