Benign but recurrent: gigantomastia due to juvenile fibroadenoma and pseudoangiomatous stromal hyperplasia

We report the case of a young, nulliparous woman who presented with bilateral gigantomastia secondary to juvenile fibroadenomas and pseudoangiomatous stromal hyperplasia (PASH). Despite undergoing multiple lumpectomies and reduction mammoplasty, she developed recurrent disfiguring breast enlargement with a significant psychosocial impact. Imaging and biopsy confirmed the presence of benign fibroepithelial lesions without malignant features. Given the aggressive recurrence, she underwent bilateral nipple-sparing mastectomy with immediate implant and latissimus dorsi flap reconstruction. Histopathological examination revealed fibroadenomatoid change with stromal fibrosis and PASH-like areas. This case highlights the rare but aggressive behaviour of juvenile fibroadenomas with coexisting PASH and underscores the need for early definitive surgical intervention in select patients. A multidisciplinary, patient-centred approach is essential to address both clinical and psychosocial needs, especially in young women in conservative sociocultural contexts.