Virginal Breast Hypertrophy: a case report and revision of current literature

Virginal breast hypertrophy (VBH) is a rare and benign condition that usually presents in adolescents as a rapid and exaggerated growth of the mammary gland in a unilateral or bilateral fashion.

Although its etiology remains unknown, histopathological and biochemical findings point towards an increased sensitivity of the estrogen receptors located in the breast tissue to normal blood levels of estrogen.

In this poster, we present the case of an 11-year-old girl, premenarcheal, with no relevant past medical history, who consulted for erythema and painless asymmetrical growth in both breasts during the previous 10 days.

Despite treatment with NSAIDs and oral antibiotic therapy, symptoms worsened during the next weeks. Blood tests, including a complete hormonal study, showed no alterations; and ultrasound imaging was normal. A breast tissue biopsy was then performed, obtaining a result of "epithelial and angiomatous hyperplasia of breast stroma".

Given these outcomes, virginal breast hypertrophy was accepted as a diagnosis of exclusion.

The patient underwent bilateral reduction mammaplasty in an effort to avoid mastectomy and achieve better results in terms of aesthetics. During immediate post-op, she presented unilateral hematoma and secondary partial nipple-areola complex necrosis.

Two months post-op, and after menarche, she presented with unilateral left side recurrence. A bilateral nipple-sparing mastectomy was then performed.

One year after mastectomy, the patient remains free of recurrence, and she is ready to start with her implant-based breast reconstruction with tissue expanders.

For the purpose of this case, a revision of the literature about virginal breast hypertrophy was performed. Of a total of 86 publications evaluated, 55 of them were "Case report" articles; a total of 75 cases were reviewed, and only 64 of them satisfied inclusion criteria. 65% of the cases were treated with reduction mammaplasty, while 27% of the cases underwent mastectomy. The remaining 8% followed medical treatment. Among surgical cases, 61.5% (24) of reduction cases presented recurrence, as opposed to 20% (3) of mastectomy cases. Medical treatment, Tamoxifen in particular, could be considered as a first step, although doses and duration remain unclear and side effects should be taken into account. Articles agree surgery should be performed as soon as possible. The optimal surgical technique choice is controversial: while reduction mammaplasty allows better cosmetic outcomes, mastectomy offers a lower recurrence rate.

Breast

PSTM 2024