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Successful treatment of mammary hyperplasia in pregnancy with bromocriptine

A 23 year old woman presented in her third pregnancy at 19 weeks gestation complaining of very tender, enlarged breasts. In 1987 her first pregnancy was terminated at 7 weeks gestation for social reasons. Her second pregnancy had been complicated by a threatened miscarriage in the first trimester and by painfully enlarged breasts in the second half of the pregnancy. From 4 days postpartum, her breasts became grossly enlarged and rock hard, a condition suggestive of mammary hyperplasia (Fig. 1). Although she wanted to breastfeed, she never produced any milk. She was started on bromocriptine (2.5 mg) three times a day and danazol(200 mg) twice a day. Five weeks postpartum her breasts were smaller but discrete masses were palpable bilaterally. Truecut biopsies were performed and histological examination showed pregnancy/lactation adenosis with lobular infarction: a recognised feature of lactation hyperplasia. Her breasts subsequently involuted to their normal prepregnancy size. During the third pregnancy her breasts started to enlarge early in the second trimester. At 19 weeks gestation both breasts were enormous, engorged, and extremely painful with large veins running over their surface, and she had gained 10 kg from her prepregnancy weight. Bromocriptine (2.5 mg) three times a day was started; after 2 weeks her breast tenderness had improved markedly, although she complained of severe itching of her breasts. She was prescribed calamine lotion and chlorpheniramine (4 mg). By 28 weeks gestation her breasts were soft, much smaller, and no longer tender. She remained on the same dose of bromocriptine throughout pregnancy except once when she tried to reduce the dose on her own accord but again her breasts enlarged immediately. Her prolactin concentrations before and after bromocriptine remained within the normal pregnancy range (Fig. 2). An ultrasound scan at 32 weeks gestation showed fetal growth to be within normal limits. She went into spontaneous labour at 38 weeks gestation giving birth to a healthy boy weighing 3000 g. Bromocriptine was continued for 2 weeks after delivery. There was no tenderness or enlargement of her breasts early postpartum. When reviewed 2 weeks after delivery her breasts were involuting normally.