title: Familial severe gigantomastia and reduction with the free nipple graft vertical mammoplasty technique: report of two cases.
abstract: BACKGROUND
  : Gigantomastia, characterized by massive breast enlargement during adolescence or pregnancy, is thought to be caused by an abnormal and excessive end organ response to a normal hormonal milieu. The amputation technique with the free nipple-areola graft is the mainstay for severe macromastia, but it has been criticized because it results in a flattened, nonaesthetic breast with poor projection. This report presents two sisters with unusual, excessive breast enlargement.
  
  
  METHODS
  : The measured distance from the sternal notch to the nipple was 50 cm for the first case and 55 cm for the second case. The free nipple graft transplantation based on the vertical mammoplasty technique was used, and an average of 4,200 g of breast tissue per breast was removed. To increase breast projection, superior dermoglandular flaps were used
  
  
  RESULTS
  : The follow-up period was 24 months. The patients had long-lasting, pronounced breast mound projection, and the level of satisfaction for both cases was very high.
  
  
  CONCLUSIONS
  The ideal geometric structure of the breast is rather conical, and the authors believe that reshaping the breast tissue in a vertical plane using the vertical mammoplasty technique may be more effective in the long term and may provide better projection.
authors.affiliation: aykmis@hotmail.com
authors.forename: Aykut
authors.initials: A
authors.lastname: Misirlioglu
authors.forename: Tayfun
authors.initials: T
authors.lastname: Akoz
mesh_terms: D005260:Female; D006801:Humans; D016462:Mammaplasty / Q000379:methods*; D008875:Middle Aged; D009558:Nipples / Q000601:surgery*; D013524:Surgical Flaps