Abdul Hamid Zargar Bashir Ahmad Laway Shariq Rashid Masoodi

abdomen revealed a gestational age corresponding to 16 weeks. A diagnosis of gestational macromastia was made. The patient was given blood transfusions and the pregnancy was terminated. Hormone evaluation after termination of pregnancy revealed serum luteinising hormone of 8.14 (normal 5-25 IU/1), follicle-stimulating hormone of 5.62 (normal 5-20 IU/1) and serum prolactin of 401 (normal 170-540 mU/1). Danazol 400 mg orally was given daily for 20 days. There was no appreciable decrease in breast size. The patient was subjected to a total mastectomy with nipple and a flap of areola transplanted back. The right breast weighed 5.9 kg and the left 5.6 kg. On cut section fatty tissue was replaced by glandular tissue. Proliferation of fibrous tissue in between the lobules was seen. A solitary abscess was seen in the right breast. Gestation macromastia is exceedingly rare, Lowison et al reported two cases in 56 794 deliveries.' Gestational macromastia can manifest either in first pregnancy or after previous normal pregnancies. Manifestations usually begin in the first trimester.2 The disorder results from enhanced end-organ response to physiological amounts of various hormones.3 Throughout its development and function breast is a target organ for most hormones. Glandular proliferation which begins at puberty is intensified during pregnancy and is dependent upon progesterone. Oestrogen has a greater effect on ductular growth and prolactin appears important in coordinating these effects. Gestational macromastia in general is massive and frequently results in extensive breakdown of skin, usually around the nipple.2 A variety of treatments have been tried (see box).2-4 In this patient termination of pregnancy and Danazol 400 mg day (for 20 days) did not appreciably decrease breast size.