Mammoplasia

{{Short description|Normal or spontaneous enlargement of breasts}}

{{Infobox medical condition (new)

| name = Mammoplasia

| synonyms =

| image = Breast changes during pregnancy 1.png

| caption = It is normal for the breasts to enlarge during pregnancy.

| pronounce =

| field =

| symptoms =

| complications =

| onset =

| duration =

| types =

| causes =

| risks =

| diagnosis =

| differential =

| prevention =

| treatment =

| medication =

| prognosis =

| frequency =

| deaths =

}}

File:Histology of lactating breast, annotated.png

Mammoplasia is the normal or spontaneous enlargement of human breasts.{{cite journal|last1=Nathanson|first1=Ira T.|title=Present Concepts of Benign Breast Disease|journal=New England Journal of Medicine|volume=235|issue=15|year=1946|pages=548–553|issn=0028-4793|doi=10.1056/NEJM194610102351505|pmid=20998969 }} Mammoplasia occurs normally during puberty and pregnancy in women, as well as during certain periods of the menstrual cycle.{{cite book|author1=Ismail Jatoi|author2=Manfred Kaufmann|title=Management of Breast Diseases|url=https://books.google.com/books?id=nsUBW3-qJ9MC&pg=PA21|date=11 February 2010|publisher=Springer Science & Business Media|isbn=978-3-540-69743-5|pages=21–}}{{cite book|author1=Nagrath Arun|author2=Malhotra Narendra|author3=Seth Shikha|title=Progress in Obstetrics and Gynecology--3|url=https://books.google.com/books?id=AS3UBAAAQBAJ&pg=PA393|date=15 December 2012|publisher=Jaypee Brothers Medical Publishers Pvt. Ltd.|isbn=978-93-5090-575-3|pages=393–394}}{{cite book|author1=Ora Hirsch Pescovitz|author2=Erica A. Eugster|title=Pediatric Endocrinology: Mechanisms, Manifestations, and Management|url=https://books.google.com/books?id=9gvBlktAT6YC&pg=PA349|year=2004|publisher=Lippincott Williams & Wilkins|isbn=978-0-7817-4059-3|pages=349–}} When it occurs in males, it is called gynecomastia and is considered to be pathological. When it occurs in females and is extremely excessive, it is called macromastia (also known as gigantomastia or breast hypertrophy) and is similarly considered to be pathological.{{cite book |author1=Arnold G. Coran |author2=Anthony Caldamone |author3=N. Scott Adzick |author4=Thomas M. Krummel |author5=Jean-Martin Laberge |author6=Robert Shamberger |title=Pediatric Surgery |url=https://books.google.com/books?id=QpabASTwF_sC&pg=PA773 |date=25 January 2012 |publisher=Elsevier Health Sciences |isbn=978-0-323-09161-9 |pages=773–}}{{cite book|author=David J. Dabbs|title=Breast Pathology|url=https://books.google.com/books?id=53CN1aUnAOUC&pg=PA19|year=2012|publisher=Elsevier Health Sciences|isbn=978-1-4377-0604-8|pages=19–}}{{cite book|author1=J.P. Lavery|author2=J.S. Sanfilippo|title=Pediatric and Adolescent Obstetrics and Gynecology|url=https://books.google.com/books?id=l9XTBwAAQBAJ&pg=PA99|date=6 December 2012|publisher=Springer Science & Business Media|isbn=978-1-4612-5064-7|pages=99–}} Mammoplasia may be due to breast engorgement, which is temporary enlargement of the breasts caused by the production and storage of breast milk in association with lactation and/or galactorrhea (excessive or inappropriate production of milk).{{cite book|author1=G. P. TALWAR|author2=L .M. SRIVASTAVA|title=TEXTBOOK OF BIOCHEMISTRY AND HUMAN BIOLOGY|url=https://books.google.com/books?id=LKy0weDEFp8C&pg=PA959|date=1 January 2002|publisher=PHI Learning Pvt. Ltd.|isbn=978-81-203-1965-3|pages=959–}} Mastodynia (breast tenderness/pain) frequently co-occurs with mammoplasia.{{cite book|author=Christoph Zink|title=Dictionary of Obstetrics and Gynecology|url=https://books.google.com/books?id=EQlvzV9V7xIC&pg=PA152|date=1 January 1988|publisher=Walter de Gruyter|isbn=978-3-11-085727-6|pages=152–}}{{cite book|editor1=Michael Heinrich Seegenschmiedt |editor2=Hans-Bruno Makoski|editor3=Klaus-Rüdiger Trott|editor4=Luther W. Brady|title=Radiotherapy for Non-Malignant Disorders|url=https://books.google.com/books?id=zEOM5Oiucl8C&pg=PA719|date=15 April 2009|publisher=Springer Science & Business Media|isbn=978-3-540-68943-0|pages=719–}}

During the luteal phase (latter half) of the menstrual cycle, due to increased mammary blood flow and/or premenstrual fluid retention caused by high circulating concentrations of estrogen and/or progesterone, the breasts temporarily increase in size, and this is experienced by women as fullness, heaviness, swollenness, and a tingling sensation.{{cite book|author1=Ruth A. Lawrence|author2=Robert M. Lawrence|title=Breastfeeding: A Guide for the Medical Profession|url=https://books.google.com/books?id=1x7mCgAAQBAJ&pg=PA60|date=26 October 2015|publisher=Elsevier Health Sciences|isbn=978-0-323-35776-0|page=60|quote=The cyclic changes of the adult mammary gland can be associated with the menstrual cycle and the hormonal changes that control that cycle. Estrogens stimulate parenchymal proliferation, with formulation of epithelial sprouts. This hyperplasia continues into the secretory phase of the cycle. Anatomically, when the corpus luteum provides increased amounts of estrogen and progesterone, there is lobular edema, thickening of the epithelial basal membrane, and secretory material in the alveolar lumen. Lymphoid and plasma cells infiltrate the stroma. Clinically, mammary blood flow increases in this luteal phase. This increased flow is experienced by women as fullness, heaviness, and turgescence. The breast may become nodular because of interlobular edema and ductular-acinar growth.}}{{cite journal | vauthors = Milligan D, Drife JO, Short RV | title = Changes in breast volume during normal menstrual cycle and after oral contraceptives | journal = Br Med J | volume = 4 | issue = 5995 | pages = 494–6 | year = 1975 | pmid = 1192144 | pmc = 1675650 | doi = 10.1136/bmj.4.5995.494| quote = [M]any women report breast changes during the normal menstrual cycle, with a feeling of fullness and a tingling sensation immediately before menstruation.1 Women taking oral contraceptives also seem to experience similar breast symptoms.2 It has been claimed that there are also pronounced changes in breast volume during the normal menstrual cycle, with maximum values occurring in the week before menstruation.3}}

Mammoplasia can be an effect or side effect of various drugs, including estrogens,{{cite book|author=Robert Alan Lewis|title=Lewis' Dictionary of Toxicology|url=https://books.google.com/books?id=caTqdbD7j4AC&pg=PA470|date=23 March 1998|publisher=CRC Press|isbn=978-1-56670-223-2|pages=470–}} antiandrogens such as spironolactone,{{cite book|author=Jeffrey K. Aronson|title=Meyler's Side Effects of Cardiovascular Drugs|url=https://books.google.com/books?id=oeBgU3UwgZkC&pg=PA255|date=2 March 2009|publisher=Elsevier|isbn=978-0-08-093289-7|pages=255–}} cyproterone acetate,{{cite book|author=Elizabeth Martin|title=Concise Medical Dictionary|url=https://books.google.com/books?id=wb26BwAAQBAJ&pg=PA189|date=28 May 2015|publisher=Oxford University Press|isbn=978-0-19-968781-7|pages=189–}} bicalutamide,{{cite book|author1=Patrick C. Walsh|author2=Janet Farrar Worthington|title=Dr. Patrick Walsh's Guide to Surviving Prostate Cancer, Second Edition|url=https://books.google.com/books?id=o515mhW7yDcC&pg=PT258|date=31 August 2010|publisher=Grand Central Publishing|isbn=978-1-4555-0016-1|pages=258–}}{{cite book|author=Harvey B. Simon|title=The Harvard Medical School Guide to Men's Health: Lessons from the Harvard Men's Health Studies|url=https://books.google.com/books?id=ZS_OxSy11EsC&pg=PA403|date=3 February 2004|publisher=Simon and Schuster|isbn=978-0-684-87182-0|pages=403–}} and finasteride,{{cite book|author=Jeffrey K. Aronson|title=Meyler's Side Effects of Endocrine and Metabolic Drugs|url=https://books.google.com/books?id=BWMeSwVwfTkC&pg=PA155|date=21 February 2009|publisher=Elsevier|isbn=978-0-08-093292-7|pages=155–}}{{cite book|author1=Jacqueline Burchum|author2=Laura Rosenthal|title=Lehne's Pharmacology for Nursing Care|url=https://books.google.com/books?id=C7_NBQAAQBAJ&pg=PA802|date=2 December 2014|publisher=Elsevier Health Sciences|isbn=978-0-323-34026-7|pages=802–}} growth hormone,{{cite book|author=Sat Dharam Kaur|title=The Complete Natural Medicine Guide to Breast Cancer: A Practical Manual for Understanding, Prevention & Care|url=https://archive.org/details/completenaturalm00kaur|url-access=registration|year=2003|publisher=R. Rose|isbn=978-0-7788-0083-5|page=[https://archive.org/details/completenaturalm00kaur/page/79 79]}}{{cite journal|last1=Souza|first1=Flavio Moutinho|last2=Collett-Solberg|first2=Paulo Ferrez|title=Adverse effects of growth hormone replacement therapy in children|journal=Arquivos Brasileiros de Endocrinologia & Metabologia|volume=55|issue=8|year=2011|pages=559–565|issn=0004-2730|doi=10.1590/S0004-27302011000800009|pmid=22218437 |doi-access=free}} and drugs that elevate prolactin levels such as D₂ receptor antagonists like antipsychotics (e.g., risperidone), metoclopramide, and domperidone{{cite journal | vauthors = Torre DL, Falorni A | title = Pharmacological causes of hyperprolactinemia | journal = Ther Clin Risk Manag | volume = 3 | issue = 5 | pages = 929–51 | year = 2007 | pmid = 18473017 | pmc = 2376090 }}{{cite journal|last1=Madhusoodanan|first1=Subramoniam|last2=Parida|first2=Suprit|last3=Jimenez|first3=Carolina|title=Hyperprolactinemia associated with psychotropics-a review|journal=Human Psychopharmacology: Clinical and Experimental|volume=25|issue=4|year=2010|pages=281–297|issn=0885-6222|doi=10.1002/hup.1116|pmid=20521318|s2cid=6851723 }} and certain antidepressants like selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs).{{cite book|author1=Jeffrey A. Lieberman|author2=Allan Tasman|title=Handbook of Psychiatric Drugs|url=https://books.google.com/books?id=ddcYMIJw6GoC&pg=PA75|date=16 May 2006|publisher=John Wiley & Sons|isbn=978-0-470-02821-6|pages=75–}}{{cite journal|last1=Kaufman|first1=K. R.|last2=Podolsky|first2=D.|last3=Greenman|first3=D.|last4=Madraswala|first4=R.|title=Antidepressant-Selective Gynecomastia|journal=Annals of Pharmacotherapy|volume=47|issue=1|year=2013|pages=e6|issn=1060-0280|doi=10.1345/aph.1R491|pmid=23324513|s2cid=32428598 }} The risk appears to be less with serotonin-norepinephrine reuptake inhibitors (SNRIs) like venlafaxine. The "atypical" antidepressants mirtazapine and bupropion do not increase prolactin levels (bupropion may actually decrease prolactin levels), and hence there may be no risk with these agents. Other drugs that have been associated with mammoplasia include D-penicillamine, bucillamine, neothetazone, ciclosporin, indinavir, marijuana, and cimetidine.{{cite journal|last1=Dancey|first1=Anne|last2=Khan|first2=M.|last3=Dawson|first3=J.|last4=Peart|first4=F.|title=Gigantomastia – a classification and review of the literature|journal=Journal of Plastic, Reconstructive & Aesthetic Surgery|volume=61|issue=5|year=2008|pages=493–502|issn=1748-6815|doi=10.1016/j.bjps.2007.10.041|pmid=18054304}}

A 1997 study found an association between the SSRIs and mammoplasia in 23 (39%) of its 59 female participants.{{cite journal | vauthors = Amsterdam JD, Garcia-España F, Goodman D, Hooper M, Hornig-Rohan M | title = Breast enlargement during chronic antidepressant therapy | journal = J Affect Disord | volume = 46 | issue = 2 | pages = 151–6 | year = 1997 | pmid = 9479619 | doi = 10.1016/s0165-0327(97)00086-4| doi-access = free }} Studies have also found associations between SSRIs and galactorrhea.{{cite journal | vauthors = Coker F, Taylor D | title = Antidepressant-induced hyperprolactinaemia: incidence, mechanisms and management | journal = CNS Drugs | volume = 24 | issue = 7 | pages = 563–74 | year = 2010 | pmid = 20527996 | doi = 10.2165/11533140-000000000-00000 | s2cid = 20016957 }}{{cite journal|last1=Mondal|first1=S.|last2=Saha|first2=I.|last3=Das|first3=S.|last4=Ganguly|first4=A.|last5=Das|first5=D.|last6=Tripathi|first6=S. K.|title=A new logical insight and putative mechanism behind fluoxetine-induced amenorrhea, hyperprolactinemia and galactorrhea in a case series|journal=Therapeutic Advances in Psychopharmacology|volume=3|issue=6|year=2013|pages=322–334|issn=2045-1253|doi=10.1177/2045125313490305|pmid=24294485|pmc=3840809}}{{cite book|author=Benjamin Sadock|title=Kaplan & Sadock's Pocket Handbook of Psychiatric Drug Treatment|url=https://books.google.com/books?id=pmUuAgAAQBAJ&pg=PT312|date=26 November 2013|publisher=Lippincott Williams & Wilkins|isbn=978-1-4698-5538-7|pages=312–}} These side effects seem to be due to hyperprolactinemia (elevated prolactin levels) induced by these drugs, an effect that appears to be caused by serotonin-mediated inhibition of tuberoinfundibular dopaminergic neurons that inhibit prolactin secretion. The mammoplasia these drugs can cause has been found to be highly correlated with concomitant weight gain (in the 1997 study, 83% of those who experienced weight gain also experienced mammoplasia, while only 30% of those who did not experience weight gain experienced mammoplasia). The mammoplasia associated with SSRIs is reported to be reversible with drug discontinuation. SSRIs have notably been associated with a modestly increased risk of breast cancer.{{cite journal | vauthors = Boursi B, Lurie I, Mamtani R, Haynes K, Yang YX | title = Anti-depressant therapy and cancer risk: A nested case-control study | journal = Eur Neuropsychopharmacol | volume = 25| issue = 8| pages = 1147–57| year = 2015 | pmid = 25934397 | doi = 10.1016/j.euroneuro.2015.04.010 | s2cid = 19884975 }} This is in accordance with higher prolactin levels being associated with increased breast cancer risk.{{cite journal|last1=Hankinson|first1=S. E.|last2=Willett|first2=W. C.|last3=Michaud|first3=D. S.|last4=Manson|first4=J. E.|last5=Colditz|first5=G. A.|last6=Longcope|first6=C.|last7=Rosner|first7=B.|last8=Speizer|first8=F. E.|author8-link=Frank E. Speizer|title=Plasma Prolactin Levels and Subsequent Risk of Breast Cancer in Postmenopausal Women|journal=JNCI Journal of the National Cancer Institute|volume=91|issue=7|year=1999|pages=629–634|issn=0027-8874|doi=10.1093/jnci/91.7.629|pmid=10203283|doi-access=free}}{{cite journal|last1=Tworoger|first1=S. S.|title=Plasma Prolactin Concentrations and Risk of Postmenopausal Breast Cancer|journal=Cancer Research|volume=64|issue=18|year=2004|pages=6814–6819|issn=0008-5472|doi=10.1158/0008-5472.CAN-04-1870|pmid=15375001|doi-access=free}}

In puberty induction in hypogonadal girls and in feminizing hormone therapy in transgender women, as well as hormonal breast enhancement in women with breast hypoplasia or small breasts, mammoplasia is a desired effect.{{cite journal | vauthors = de Muinck Keizer-Schrama SM | title = Introduction and management of puberty in girls | journal = Horm. Res. | volume = 68 Suppl 5 | issue = 5| pages = 80–3 | year = 2007 | pmid = 18174716 | doi = 10.1159/000110584 }}{{cite book|author1=Gunther Göretzlehner|author2=Christian Lauritzen|author3=Thomas Römer|author4=Winfried Rossmanith|title=Praktische Hormontherapie in der Gynäkologie|url=https://books.google.com/books?id=TIs2WhfYzZ4C&pg=PA385|date=1 January 2012|publisher=Walter de Gruyter|isbn=978-3-11-024568-4|pages=385–}}{{cite book|author1=R.E. Mansel|author2=Oystein Fodstad|author3=Wen G. Jiang|title=Metastasis of Breast Cancer|url=https://books.google.com/books?id=14pb5b6gT-oC&pg=PA217|date=14 June 2007|publisher=Springer Science & Business Media|isbn=978-1-4020-5866-0|pages=217–}}{{cite journal | vauthors = Hartmann BW, Laml T, Kirchengast S, Albrecht AE, Huber JC | title = Hormonal breast augmentation: prognostic relevance of insulin-like growth factor-I | journal = Gynecol. Endocrinol. | volume = 12 | issue = 2 | pages = 123–7 | year = 1998 | pmid = 9610425 | doi = 10.3109/09513599809024960}}