A 17 year-old girl was referred to me for consideration for bilateral mastectomy. 17 years old! Approximately 2 years prior, as puberty hit full swing, her breasts rapidly increased in size. They grew to the size of watermelons on her chest.
She went to a big hospital where they performed a bilateral breast reduction. Pathology revealed a benign process of the breasts which is triggered by the hormone increase at puberty: Juvenile Hypertrophy of the Breasts. She did well for several months until the breasts began to grow again. They grew back to the same size, if not bigger than the time before. The exception was that this time, instead of nipples, large wounds and scars were noted on the breasts.
Doing a bilateral mastectomy on a young girl felt barbaric to me. After examining her, I talked to a pediatric surgeon and a breast surgeon to make a plan. I studied how to perform a breast reduction. When I discussed with the girl again, she asked me to remove the breasts completely. I told her that I would like to try to do another reduction and her reply made me smile. She said, “Please, do whatever your brain can think to do.”
I marked her breasts for the reduction and we brought her to the operating room. I made all the initial incisions on the left breast, but once the knife began to cut through the bulk of the “breast” tissue, it became clear that the breast was entirely replaced with abnormal tissue. Due to the high likelihood of the breast enlargement recurring, I abandoned the plan to do a reduction and completed a bilateral mastectomy. Drains were left bilaterally and the chest was wrapped with a large elastic bandage to prevent fluid build-up between the skin and chest wall.
Afterwards, she did great. She was grateful to have the weight lifted off her chest – a 10 kilogram weight!!! Pathology again confirmed the diagnosis of Juvenile Hypertophy of the breast.
Approximately 5 years prior, my cousin was diagnosed with breast cancer at the age of 40, underwent a bilateral mastectomy and reconstruction and is doing well today (she even wrote a book about it). She and her mom (my aunt) have become very involved in supporting other women who have undergone mastectomy. I contacted them to find some bra prostheses and she was able to send some “knitted knockers” with a volunteer.
About 3 months after surgery, my patient came back to get the prostheses. Her chest was well-healed (although I wished I hadn’t used staples). She was wearing clothes that actually fit her body size. I explained that she didn’t necessarily have to wear the prostheses all the time, but she at least now had an option.
The referring doctor sent me a photo of her months later. She was smiling, wearing a dress that fit her perfectly with the profile of appropriately sized “breasts.”