Modified Thorek Mammoplasty for the Treatment of Idiopathic Gigantomastia

Idiopathic gigantomastia is a rare and severe condition characterized by excessive breast enlargement, which often causes significant physical and psychological distress. Although various surgical techniques have been described for the management of this condition, there is no universally accepted approach. This case report discusses the surgical management of a 29-year-old female patient with idiopathic gigantomastia using a modified Thorek reduction mammoplasty technique. The modified technique involved incorporating a superomedial pedicle to preserve breast volume. The superomedial dermoglandular flap was designed and adapted to the upper margin of the areola, providing autoaugmentation to restore breast volume and prevent post-operative ptosis. This modification allowed for the preservation of the breast’s natural projection while achieving a satisfactory aesthetic result. The nipple-areola complex was grafted onto the pedicled flap, avoiding the risks of pedicle-based techniques due to the patient’s existing breast anatomy and tissue characteristics. Following the surgery, the patient experienced no complications, and her post-operative appearance was significantly improved, with both physical symptoms and psychological distress alleviated. The total excised tissue weighed 3546 grams from the right breast and 4487 grams from the left, reflecting the extent of the hypertrophy. This report highlights the efficacy of the modified Thorek mammoplasty technique, particularly in cases of severe gigantomastia, and suggests that the incorporation of a superomedial pedicle can be an effective strategy for maintaining breast volume and ensuring an aesthetically pleasing outcome.