Pediatric and adolescent breast hypertrophy

What is pediatric and adolescent breast hypertrophy?

Pediatric and adolescent breast hypertrophy (hy·​per·​tro·​phy), which really just means overgrowth of breast tissue, is a condition in which breasts grow so heavy that they cause problems. Common complaints with this condition are neck or back pain, rashes developing in the skin folds under the breasts and embarrassment about the shape and size of the breast.

The main consequences of breast hypertrophy are those associated with the weight of the breasts: poor posture, pain in the upper back, neck and shoulders, difficulty with sports and exercise and the discomfort of bra straps digging into the shoulders; but many women with this condition also complain of discomfort within the breasts themselves, headaches, and rashes or even ulcers developing in the skin folds under the breasts. 

Breast hypertrophy can be divided into macromastia and gigantomastia, the cut offs are fairly arbitrary with the latter defined as breast tissue over that expected by the patient’s body type of more than 5.5lb, or breasts weighing more than 3% of total body weight.

Even though the condition is a spectrum without discrete different types, it is helpful to consider breast hypertrophy in terms of how large and heavy the breasts are and whether the breast hypertrophy is associated with obesity, as this affects which type of breast reduction surgery can be offered, if any, and it also affects whether an insurance company would consider covering any treatment.

What are signs and symptoms of pediatric and adolescent breast hypertrophy?

There is no specific lab test for breast hypertrophy, and the diagnosis is made by most women themselves and confirmed by clinical assessment. More important than the diagnosis itself is an assessment of how the size and weight of the breasts is affecting the individual and planning whether surgery is a good option to address the problem, either immediately or in the future.

Signs to look for include the size of the breasts themselves but also the physical consequences of the breast weight:

• Poor posture
• Pain in the upper back
• Neck and shoulders
• Difficulty with sports and exercise
• Discomfort of bra straps digging into the shoulders
• Discomfort in the breasts themselves
• Skin rashes in the skin folds under the breasts

What are the causes of pediatric and adolescent breast hypertrophy?

Breast hypertrophy has various different causes including a patient’s genetics, oversensitivity to or overproduction of estrogens and being overweight. Although there is often a difference between a woman’s breasts, this is almost always the case in breast hypertrophy.

Breast hypertrophy is more common in overweight women but there is a very real association between a patient’s body mass index (BMI), a measure of weight compared corrected for the height of the patient, and complications following surgery for breast hypertrophy.

Patients who are overweight have roughly three times the risk of complications of patients of an ‘ideal’ BMI, and obese patients have roughly twelve times the complication risk. For this reason, women are often encouraged to lose weight before undertaking surgery for breast hypertrophy.

How is pediatric and adolescent breast hypertrophy treated?

Breast reduction surgery - The main surgical treatment is breast reduction surgery and this operation is very effective at improving the quality of life of women affected. Deciding whether and when to undergo this surgery, however, is a big decision as it does leave scars on the breasts, can have consequences for breast feeding, and, although the risks are small, there is the potential for significant complications from the operation.

There are several key differences in treating breast hypertrophy in a pediatric setting. The first is that, although breast reduction surgery is very effective in relieving symptoms and improving quality of life, undertaking surgery before breast development is complete runs the risk of the breasts continuing to grow following surgery, for the symptoms to return and for the treatment to be inadequate. Likewise, breast size and weight is dependent on the overall body weight so any weight gain following surgery may result in further breast growth and the return of problematic symptoms.

It is also important to consider that during pregnancy, it is common for breasts to grow, and patients who have undergone surgery prior to having children should be aware that they may have further symptoms from their breasts after this stage in their lives, and that they may require further surgery in the future. It is also important for patients to know that surgery for breast hypertrophy involves the milk producing tissue of the breast and, although many women can breast feed following this type of surgery, a proportion cannot. The decision of whether and when to go ahead with treatment involves balancing the problems caused by the breast hypertrophy with all of the factors mentioned.