By Cathy Enns August 4, 2011
The hormones produced by the various glands of the endocrine system occasionally go haywire, with results that range from mild to life-threatening. One of the most notorious problems related to a malfunctioning gland is type 1 diabetes, traced back to faulty insulin production of the pancreas (The Hormone Foundation 1).
The so-called sex hormones — products of the pituitary gland, the testes and the ovaries — can go awry as well, resulting in unusual development of male and female traits (The Hormone Foundation 1). One of the stranger conditions that can affect adolescent girls is called juvenile hypertrophy of the breast (JHB), or virginal mammary hypertrophy and sometimes juvenile gigantomastia.
Though the development of JHB is believed to be rooted mainly in the sex hormones — perhaps a result of exaggerated response to estrogen — the actual mechanism behind the condition is not well understood. The effect is obvious, however, as the young patient experiences rapid and dramatic growth of one or both breasts (Güneş 1).
A group of Turkish researchers had the opportunity to study the condition as part of their 4-yearlong work with one patient. The team noted that the breast(s) exhibiting this out-of-control growth are usually pendulous and firm, and can end up as large as 22.5 kg (almost 50 pounds!). Their young patient presented with one normal breast and one that had undergone rapid growth over the previous two months, becoming tender and warm (Güneş 1).
The Turkish physicians noted that their patient’s enlarged breast presented neither physical nor psychological challenges (Güneş 1). Unfortunately, that’s not always the case. Just as for women who have developed normal but very large breasts, physical problems can include neck pain, back pain, shoulder pain and skin rashes. Quality of life issues are also common, from dissatisfaction and embarrassment to restriction of physical activity (ASAPS 1).
There are four possible courses of treatment, according to the Turkish doctors: breast reduction, mastectomy with breast implants, hormone therapy and a combination of surgery and medication.
The team reported that treatment with estrogen-suppressing drugs can be an option, with tamoxifen, usually associated with post-breast cancer patients, seemingly the most effective. Unfortunately, hormone manipulation is not always the best choice for adolescent girls (Güneş 1).
They explained that breast reduction is the most common approach to treating JHB, but the risk of recurrence is relatively high. In a paper published just last month, researchers from the U.S. agreed. In an article published in Plastic and Reconstructive Surgery, the Journal of the American Society of Plastic Surgeons, four physicians reported finding that mastectomy, while admittedly deforming the patient, was the procedure least likely to result in recurrence of JHB. (Hoppe 1).
Until more can be learned, then, there’s no perfect solution for those who suffer from the condition. And because there’s not yet a treatment that reliably yields a good outcome, it’s important to seek out a doctor who’s experienced with JHB. Patience, perseverance and partnership are key to finding the way forward.
Fortunately JHB is as rare as it is strange, and those who do develop one or both enlarged breasts in adolescence can take small comfort from the fact that the condition itself is benign.