|Year : 2013 | Volume
| Issue : 1 | Page : 79-81
Unilateral macromastia in a case of polymastia
Bharat B Dogra, Gurjit Singh
Department of Surgery, Padmashree Dr. D. Y. Patil Medical College, Hospital & Research Centre, Dr. D. Y. Patil Vidyapeeth, Pimpri, Pune, India
|Date of Web Publication||14-Mar-2013|
Bharat B Dogra
Department of Surgery, Padmashree Dr. D. Y. Patil Medical College, Hospital & Research Centre, Dr. D. Y. Patil Vidyapeeth, Pimpri, Pune
Source of Support: None, Conflict of Interest: None
Macromastia is a condition of abnormal enlargement of the breast in excess of the normal proportion. It can be unilateral or bilateral and generally manifest at puberty when secondary sexual characters start appearing. Other patients may develop this condition at the time of pregnancy (Gestational macromastia). We present a case of young unmarried girl having unilateral macromastia due to polymastia. Unique feature in this case has been presence of two nipple areola complexes over right breast mound, one at normal site and another just superior to the inframammary crease in the line of embryonic milk line. The affected breast was almost double the size of contra lateral breast. Besides she also had bilateral hypertrophy of axillary breasts. Vertical scar reduction mammaplasty along with excision of axillary breasts was successfully carried out with gratifying results.
Keywords: Macromastia, polymastia, reduction mammaplasty
|How to cite this article:|
Dogra BB, Singh G. Unilateral macromastia in a case of polymastia. Med J DY Patil Univ 2013;6:79-81
| Introduction|| |
Abnormal enlargement of breast beyond the normal proportion is called macromastia.  Polymastia is a congenital anomaly presenting with accessory breast along the embryonic milk line extending from the axilla to the groin.  While polythelia refers to the presence of an additional nipple areola complex over an area in the line of milk line, polymastia denotes the much rarer presence of additional mammary gland and macromastia is a condition of abnormal enlargement of the breast in excess of the normal proportions.
Patients with macromastia may present with enlarged breasts which tend to be ptotic and may cause chest, neck, back or shoulder pain, and complain of inability to fit into proper clothing.
We present a case of unilateral macromastia due to polymastia, who was successfully managed by vertical scar reduction mammaplasty, with gratifying results.
| Case Report|| |
A 19-year-old young unmarried girl reported to us with the complaints of asymmetrical enlargement of her breasts since puberty. She had difficulty in fitting right breast in her bra, and occasional history of pain in the back and right shoulder. She had well-developed breasts and right breast was almost double the size of her other breast [Figure 1]. This breast had two nipple areola complexes, one at normal site and accessory one about 3 cms superior to the inframammary crease and the crease on affected side also happened to be at alevel which was lower as compared to the contralateral side [Figure 2] Besides, she had bilateral axillary breasts as well.Vertical scar reduction mammaplasty was carried out for macromastia and accessory breast tissue in each axillary region was excised in same sitting [Figure 3]. Preoperative marking was carried out in standing position based on Lejour technique.  The future nipple on the affected side was marked about 21 cms from the suprasternal notch to match the distance with the normal side. Breast meridian was drawn from inframammary crease downwards 9 cms from midline and lateral borders of breast tissue to be excised were marked by pushing the breast tissue medially and laterally and inferior end of the lateral borders was kept about 2 cms superior to the inframammary crease. Resection of accessory breast tissue included the accessory nipple areola complex [Figure 4]. Resected tissue weighed 500 grams and residual gland was transposed to simulate the shape of contralateral breast. Post op recovery was uneventful. On review after 6 months, she had stretching of scar at areolar margin [Figure 5] and was offered revision of scar but she was not keen for that. Vertical scar had well settled at the time of review.
|Figure 1: Asymmetrical breasts, right almost double than contralateral breast|
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|Figure 4: Resected breast tissue including accessory nipple areola complex|
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| Discussion|| |
Breast anomalies have a significant negative impact on women's health status, self image, confidence and overall quality of life.  Development of breast occurs during the fourth to fifth week of fetal development, when primitive milk streaks or galactic bands develop. At 6-8 weeks intrauterine life, primary bud forms with the thickening of mammary analage, which penetrates into chest wall.mesenchyme.  At 7-8 weeks intrauterine life, mammary ridge disappears leaving only the breast tissue at the level of 4 th ic space. We believe that mammary ridge in our case persisted at the level of 4 th as well as 5 th ic space, hence the development of macromastia due to polymastia.
Incidence of accessory breast tissue ranges between 0.22 and 6% of the general population.  Heuston also noted that patients experience difficulty in concealing asymmetry if greater than 33% in normal daily attire  Reduction mammaplasty in such cases is not only a cosmetic but a functional surgical procedure, with immense health benefits.  Asymmetrical size of the two breasts may prompt the patient to seek medical attention at an early date as happened in our case.
Sojitra et al,  in his series of asymmetrical breasts, used modified vertical scar breast reduction technique to simulate the shape and size of the smaller breast. This "minimal scar technique" for breast reduction, developed by Marchac, Lassus and Lejour, has become an increasingly popular procedure.  Araco et al.  in a study of 177 cases of breast asymmetries, unilateral hypertrophy was treated by reduction mammaplasty. Piza-Katzer  studied 11 teenagers with asymmetrical breasts and concluded that asymmetrical breasts are an aesthetic problem for teenagers that should be dealt with by a plastic surgeon before it causes significant psychosocial problems. Incision placement is crucial, and attempts must be made to ensure that the scar is well hidden. Vertical scar reduction mammaplasty has the advantage of reduced scar burden and improved long-term projection of the breasts. 
| Conclusions|| |
Polymastia as well as macromastia in isolation is common congenital anomaly, but macromastia due to polymastia is a rare anomaly and hence being presented. Unilateral asymmetry due to macromastia affects the person not only psychologically but physically as well. Vertical scar reduction mammaplasty is one of the options to correct this deformity and this procedure has been recommended by various authors because of low scar burden and satisfactory breast projection.
| References|| |
|1.||Rahman GA, Adiqunt IA, Yusuf IF, Bamiqbade DP. Macromastia and bilateral axillary breast hypertrophy: A case report. Niger Postgrad Med J 2010;17:45-9. |
|2.||Charoenkul V, Jimarkon P. Gigantic Bilateral Aberrant Axillary breasts: A case report. Mt Sinai J Med1978;45:455-9. |
|3.||Gabka CJ, Bohmert H, Blondeel PN. Plastic and Reconstructive Surgery of the Breast. 2 nd ed.New York, USA: Thieme; 2008. p. 38-41 |
|4.||Collins ED, Kerrigan CL, Kim M, Lowery JC, Striplin DT, Cunningham B, et al.The Effectiveness of Surgical and Non-surgical Intervention in Relieving the Symptoms of Macromastia. Plast Reconstr Surg 2002;109:1556-66. |
|5.||Shermak MA. Congenital and developemental abnormalities of breast: Management of Breast Diseases. Berlin Heidelberg: Springer-Verlag; 2010. p. 37-51. |
|6.||Heuston JT. Unilateral agenesis and hypoplasia: Difficulties and suggestions In: Goldwyn RM, editor. Plastic and Reconstructive surgery of the Breast. Boston: Little Brown; 1976. p.361-73. |
|7.||Blongvist L, Ericksson A, Brandberg Y. Reduction mammaplasty provides long-term improvement in health status and quality of life. Plast Reconst Surg 2000;106:991-97. |
|8.||Sojitra NM, Ion L, Jain A, Makki AS, Asplunde OA. Unilateral vertical scar breast reduction with glandular transposition of the nipple-areola in breast asymmetry. Plast Reconstr Surg 2005;116:114-23. |
|9.||Araco A, Gravante G, Araco F, Gentile P, Castrì F, Delogu D, et al. Breast asymmetries, A brief review and our experience: Aesthetic Plast Surg 2006;30:309-19. |
|10.||Piza-Katzer H . Reduction mammaplasty in teenagers , Aesthetic Plast Surg 2005;29:385-90. |
|11.||Lista F, Ahmad J. Vertical scar reduction mammaplasty: A 15-year experience including a review of 250 consecutive cases, Plast Reconstr Surg 2006;117:2152-65; discussion 2166-9. |
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]