Giant Lipoma of the Breast
A 55-year-old otherwise healthy female arrived at our plastic surgery department with a diagnosis of benign breast hypertrophy, referred by the oncologist for reduction mammoplasty. She reported a progressive increase in her breast size over the previous 20 years, being more evident in the right side. Otherwise asymptomatic, she was concerned about the asymmetry of her breasts and the possibility of a cancerous tumor. A preoperative examination revealed a bilateral increase in breast size, with severe asymmetry based on marked enlargement of the right side. The ptotic breasts were soft and no palpable masses were identified (). There was no local heat sensation or manifestations of systemic disease. A preoperative screening mammogram showed no masses or other suspicious abnormalities. Benign breast hypertrophy associated with breast asymmetry was diagnosed, and reduction mammoplasty planned. Preoperatively, the patient was marked as for an inferior pedicle and Wise pattern reduction mammoplasty. Through an incision in the lateral vertical limb of the inferior pedicle, a 2,500 g lipoma of the right breast was removed, comprising most of its mass, resulting in a volume deficit with excess skin (). The tumor had a subglandular location, and the atrophic breast glandular tissue was compressed anteriorly and inferiorly, displacing the nipple areola complex; a thin capsule created a clear demarcation between the tumor and glandular tissue. A morphologic examination demonstrated a wide uniform mass that measured 24 cm×20 cm×6 cm covered by a thin capsule (). Reconstruction proceeded with de-epithelialization of the redundant skin, and folding in the dermis and glandular tissue in the medial and lateral triangles, tacking them superiorly instead of resecting them to restore the volume deficit by autologous augmentation. No glandular tissue was resected. The contralateral breast was treated in a similar fashion, 800 g of tissue was resected for inferior pedicle breast reduction with no evidence of a tumor. In both breasts, upper pole fullness was achieved by plication of the upper de-epithelized and undermined flaps to the pectoralis major fascia in a higher position relative to the breast meridian. Symmetry and viability of the nipple areola complex were achieved. After 6 months of follow-up in the outpatient clinic, a satisfactory outcome was shown (). The pathology results revealed a lipoma composed of benign adipocytes with no neural component or malignant transformation.