Breast development is a vital part of a woman’s reproductive life. That is why Mkawughanga Bertin was not bothered when her a breast started growing when she was very young.
However, things moved from bad to worse as her breasts couldn’t stop growing. In Class Five she was already insecure about her body. She hated Physical Education lessons and games. She used to go to the field to sit and other times she used to lie about being unwell so that she could stay in class. She only engaged in swimming.
“My condition affected me physically, socially, and psychologically. The lowest point was when a teacher said that my breasts were big because I was sexually active. Then I was in my early puberty years. Later on, in high school, a story went round that I had aborted and that’s why I had big breasts. I got branded names on the road and this made the whole situation even worse,” she says.
There are times she would wear two bras just to support her breasts. Her biggest challenge was getting the right fit. She also had to purchase bras often as her breasts were constantly growing. This really affected her mental health. On top of that, doing house chores also turned problematic. She always needed assistance to complete them or used to take long breaks in between so that she could get them done.
“I used to have back problems and shoulder scars because of the bras, I couldn’t carry heavy things or do heavy tasks. Doing laundry was so hard for me, even mopping the house despite using a mop. I couldn’t stand for so long either All this really affected my mental health and I was on antidepressants all through, something I never talked to the doctors about,” she reveals.
Rare condition In quest to find a solution for her problem, she conducted some research. That is when she realised she was suffering from a condition known as gigantomastia autoimmune disorder. This is a rare condition that is characterised by excessive female breast growth often with or without physical or psychosocial symptoms.
According to Dr Martin Ajujo, plastic reconstructive and aesthetic surgeon under Nairobi Metropolitan Services, the exact mechanism by which gigantomastia occurs in the body isn’t well understood. Genetics and an increased sensitivity to female hormones, such as prolactin or oestrogen, are thought to play a role. For some women, gigantomastia happens spontaneously without an obvious cause, during puberty or pregnancy or while taking certain medications.
If not corrected it can result in chronic pains, dislocation of joints such as the back/ spine and shoulders, chronic ulceration/ wounds, excessive weight gain resulting from limited physical activities and mental illness as a result of psychosocial distress.
“There is no other effective treatment for gigantomastia apart from breast reduction surgery. This surgery offers the highest satisfaction rate in terms of relief of symptoms. It also alleviates the suffering from excessively enlarged breasts,” says Ajujo.
The surgery ideally involves breast lift and contouring in respect of plastic surgery principle of combining form, function, and aesthetic while operating. It eases discomfort and helps one to achieve a breast size proportional to their body.
Available research also shows if this condition is not corrected, one can develop
degenerative kyphosis, a condition in which a per son’s spine curves forward, forming a hump or hunchback. While kyphosis itself is painful and physically limiting, its progression could further lead to shortness of breath due to lung compression.
Moreover, if the nerves running through the spine become compressed or pinched due to its bending, the nerve signals could get disrupted and cause numbness or weakness in the limbs, problems with the sense of balance and even loss of normal bladder or bowel control Though at first, she wasn’t willing to go under the knife, by 2018 she was tired of her breasts and she was ready for the operation. She tried getting insurance compaies on board, but they couldn’t fund her surgery terming it cosmetic despite that she had a doctor’s request explaining the need for it.
Two years later, she had moved from bra cup size 36F to 36HH or 36J. The pain she was going through made her family look for finances from all corners. Through the help of the Gigantomastia Foundation, her surgery was done in August 2020, and a total of 3.7kgs was removed from her chest. Now, with newfound comfort and confidence, she loves her body and breasts even more.
“I had my surgery on August 23. Aftercare took around three to four weeks and I was okay. The first week I used to go for the dressing twice and after that, once a week,” she says.
Dr Ajujo reveals that despite the condition being a psychologically and physically disabling, it remains undiagnosed in most cases. This is basically because there is still no universal classification or accepted definition for it.
Moreover, often women themselves do not know or acknowledge that they have disproportionately large breasts and, therefore fail to seek medical help.
“This is one of the race conditions affecting more Kenyans than expected. Every week about five patients visit the hospital with gigantomastia. On average we attend to between 20-30 patients in a month,” he says.
And since there is no breast size, which can be considered abnormal, Ajujo says that anyone suffering from constant neck, shoulder, and back pains, bra strap grooving, skin changes or infection below the breast, limitation of physical activities including exercise, difficulty in finding fitting bras and dresses, stigma, and psychological distress including low self-esteem might be having gigantomastia.
Though most doctors tend to see this condition following a family line, it is not inherited. Apart from women it also affects men, with the male version known as gynaecomastia. For men, this happens due to hormonal changes, medication, malignancy, or spontaneous.
“Men have profound psychosocial distress from gynaecomastia with battered selfesteem. Correction on gynaecomastia leads to dramatic changes in the psychological wellbeing of affected patients,” he adds.
And what are some of the challenges patients with this condition face trying to get treatment?
Dr Ajujo says the most profound challenge is lack of awareness and appreciation of
the condition both in public, leading to stigmatisation and from healthcare players leading to denial or delay of care. This ranges from healthcare workers at different levels, to medical insurers and other financiers. The other barriers to treatment include cost, delayed referrals, and beliefs and customs.
He notes that the belief that most women who undergo this surgery do so for cosmetic improvement is not true because most women who undergo breast reduction surgery are more interested in physical relief than cosmetic improvement.
On who determines the weight to be removed from the breasts, Dr Ajujo says the desired cup size, body frame, and breast tissue determines the amount of weight to be removed. An experienced surgeon should be able to estimate the weight to be removed and during the surgery one is guided by the form and symmetry on how much more tissue to remove. “Breast reduction surgery is part of basic training for plastic surgeons thus any competent plastic surgeon should be able to perform one. However, the more experience a doctor has performed breast reduction surgery the better prepared he or she is to anticipate and prevent complications,” he adds.
He reveals that one can have breast reduction surgery at any age sometimes even as a teenager. But if the breasts aren’t yet fully developed, one might need a second surgery later in life.
MORE ABOUT GIGANTOMASTIA
• breast pain (mastalgia)
• pain in the shoulders, back, and neck
• redness, itchiness, and warmth on or underneath the breasts • poor posture
• infections or abscesses
• loss of nipple sensation
• breast asymmetry (when one breast is larger than the other)
• temporary or permanent nerve damage, resulting in loss of nipple sensation • difficulty playing sports or exercising
Complications in pregnancy, child care • poor growth of the foetus
• spontaneous abortion (miscarriage)
• suppression of milk supply
• mastitis (breast infection)
• blisters and wounds because the baby can’t latch on properly • skin rashes under the breasts
• body image problems
• avoidance of social activities