Mammoplasia
Mammoplasia is the normal or spontaneous enlargement of human breasts.[1] Mammoplasia occurs normally during puberty and pregnancy in women, as well as during certain periods of the menstrual cycle.[2][3][4] When it occurs in males, it is called gynecomastia and is considered to be pathological.[4] 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.[5][6][7] 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).[8] Mastodynia (breast tenderness/pain) frequently co-occurs with mammoplasia.[9][10]
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.[11][12]
Mammoplasia can be an effect or side effect of various drugs, including estrogens,[2][13] antiandrogens such as spironolactone,[14] cyproterone acetate,[15] bicalutamide,[16][17] and finasteride,[18][19] growth hormone,[20][21] and drugs that elevate prolactin levels such as D2 receptor antagonists like antipsychotics (e.g., risperidone), metoclopramide, and domperidone[22][23] and certain antidepressants like selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs).[23][24][25] The risk appears to be less with serotonin-norepinephrine reuptake inhibitors (SNRIs) like venlafaxine.[26] 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.[22] Other drugs that have been associated with mammoplasia include D-penicillamine, bucillamine, neothetazone, ciclosporin, indinavir, marijuana, and cimetidine.[6][27]
A 1997 study found an association between the SSRIs and mammoplasia in 23 (39%) of its 59 female participants.[26] Studies have also found associations between SSRIs and galactorrhea.[24][28][29][30] 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.[26][28][29] It is noteworthy that 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).[26] The mammoplasia associated with SSRIs is reported to be reversible with drug discontinuation.[30] SSRIs have notably been associated with a modestly increased risk of breast cancer.[31] This is in accordance with higher prolactin levels being associated with increased breast cancer risk.[32][33]
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.[34][35][36][37]
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