Breast Hypertrophy (Macromastia)

What breast hypertrophy is

Breast tissue is made of glands, fat and connective tissue. Breast hypertrophy happens when this tissue grows excessively. There is no single cutoff for "too large". Doctors focus on whether breast size causes symptoms and how it compares with body size. A single breast can be affected (unilateral hypertrophy), causing noticeable asymmetry.

Causes and risk factors

• Hormonal sensitivity: breast tissue in some people is especially responsive to normal levels of estrogen and progesterone
• Genetics: breast size often runs in families
• Weight gain: more fat stored in the breasts
• Pregnancy and breastfeeding
• Medicines: some hormonal treatments, and rarely D-penicillamine, cyclosporine and others
• Autoimmune conditions have been linked to some cases of gigantomastia

In men, breast enlargement is a different condition called gynecomastia.

Symptoms

• neck, upper back and shoulder pain
• headaches linked to neck strain
• deep, painful grooves in the shoulders from bra straps
• rashes, chafing, sweating and skin infections under the breasts (intertrigo)
• tingling or numbness in the arms or hands
• rounded, stooped posture
• breast pain and heaviness
• difficulty running, exercising and finding clothes that fit
• trouble sleeping comfortably
• self-consciousness, unwanted attention and lower self-esteem, especially in teenagers

Diagnosis

Breast hypertrophy is diagnosed from symptoms and examination. A doctor will:

• ask about pain, skin problems, activity limits, weight changes, medicines and pregnancy
• examine the breasts, posture and shoulders, and check for lumps
• measure distances such as from the collarbone notch to the nipple, and sometimes estimate breast tissue volume

Imaging is not needed to diagnose macromastia itself. A mammogram is recommended before surgery for people over about 40, or according to screening guidelines. Ultrasound is used in younger people if a lump is felt. Hormone tests may be checked in unusually rapid growth.

Treatment

Non-surgical options

• A professionally fitted bra: many people wear the wrong size. A supportive bra with wide, padded straps and a firm band carries most of the weight on the band rather than the shoulders
• Sports bras with encapsulated cups for exercise
• Physical therapy: strengthening of the upper back and core and posture training
• Weight loss, which can reduce breast size in some people
• Skin care: keep the skin under the breasts clean and dry, use cotton liners, and treat fungal rashes with antifungal creams
• Pain relief: acetaminophen (paracetamol) or ibuprofen at the label dose for flare-ups

These measures can ease symptoms but do not change breast size significantly.

Breast reduction surgery

Breast reduction (reduction mammaplasty) removes breast tissue, fat and skin and lifts the breast and nipple to a higher position.

• Effectiveness: studies consistently show large improvements in neck, back and shoulder pain, headaches, skin problems, exercise and quality of life. Patient satisfaction is very high
• Timing: usually after breast growth has stopped, ideally when weight is stable. Teenagers with severe symptoms may be considered earlier
• Recovery: most people return to desk work in 1 to 2 weeks and to full exercise in about 6 weeks
• Risks: scars, changes in nipple sensation, wound-healing problems, asymmetry, and a reduced ability to breastfeed in some people
• Insurance: many US insurers cover breast reduction when symptoms are documented and conservative treatments have been tried, often with requirements about the amount of tissue removed

Gigantomastia

Treatment may include hormonal or anti-estrogen medicines, stopping a causative medicine, and surgery, sometimes after pregnancy. Gigantomastia in pregnancy is managed by a specialist team.

Living with large breasts

• get a professional bra fitting once or twice a year
• use a supportive sleep bra if lying down is uncomfortable
• choose low-impact exercise such as swimming, cycling or elliptical training
• see a doctor for persistent rashes or pain
• talk to someone, such as a doctor or counselor, if breast size affects mood or confidence

Frequently asked questions

What is breast hypertrophy?

It is breast enlargement that is out of proportion to the body and causes symptoms such as neck, back and shoulder pain, bra strap grooves and skin rashes. It is also called macromastia. Its severe, rapid form is called gigantomastia.

Can large breasts cause back pain?

Yes. Heavy breasts pull the shoulders forward and strain the muscles of the neck and upper back, causing pain, headaches and posture changes. A well-fitted bra and back-strengthening exercises can help, and breast reduction surgery relieves pain in most people.

Will insurance cover breast reduction for macromastia?

Often, if breast size causes documented physical symptoms that have not responded to conservative measures such as supportive bras and physical therapy. Requirements vary between insurers and may include a minimum amount of tissue to be removed. Your surgeon's office can help with approval.

What is juvenile breast hypertrophy?

It is rapid, excessive breast growth that starts around puberty and may continue for months or years. Hormone levels are usually normal. It can cause significant pain and distress. Treatment may include breast reduction surgery once growth slows, sometimes with hormonal medicines.

Can breastfeeding happen after breast reduction?

Many people can breastfeed after breast reduction, at least partly, especially when techniques preserve the connection between the nipple and the underlying glands. Some cannot. Discuss your future plans with your surgeon before surgery.