Virginal Mammary Hypertrophy: A Meta-Analysis and Treatment Algorithm

Background: Virginal mammary hypertrophy, a rapid enlargement of one or both breasts that usually presents in the adolescent years, is a rare condition that has been reported sporadically in the medical literature. Currently, there are no patient- or disease-oriented evidence-based guidelines for the treatment of this condition. This meta-analysis examines the published case reports and presents a cumulative algorithm for the diagnosis and treatment of this uncommon condition. Methods: A literature search was performed using PubMed, with multiple keywords. Information regarding patient age, menarchal state, mass of excision, surgical technique, number of operations, pharmacologic intervention, and recurrence was extracted from each case report and analyzed using SPSS 15.1 statistical software. Results: A significant relationship was found (p < 0.01), as was an odds ratio of 7.0, for the likelihood of recurrence using a reduction mammaplasty as opposed to a mastectomy. Conclusions: Based on the evidence presented in this article, certain interventions are more effective for the treatment of virginal mammary hypertrophy. On diagnosis of virginal mammary hypertrophy, tamoxifen therapy may be considered based on previous literature, barring any medical contraindications. A subcutaneous mastectomy with complete removal of breast tissue is the procedure least likely to lead to recurrence but is more deforming. Reduction mammaplasty gives an improved aesthetic breast, but it is important to counsel the patient on the likelihood of increased recurrence. Tamoxifen therapy following surgery may decrease the recurrence rate.