Case Presentation: A twenty-year-old woman with macromastia and a diagnosis of diffuse dermal angiomatosis (DDA) presented desiring reduction mammaplasty. Prior to surgery, mammography and extensive laboratory testing ruled out systemic or underlying malignant breast pathology.

Results: The patient underwent bilateral Wise-pattern reduction mammaplasty with free nipple grafting for the treatment of both her macromastia and her DDA with acceptable cosmetic results and without recurrence of the lesions.

Discussion: Diffuse dermal angiomatosis is an extremely rare, benign dermal vascular proliferative disorder that has been infrequently reported on the breast. The clinical features of the disorder include painful, poorly circumscribed, erythematous plaques which often exhibit central ulceration. The condition has been reported in the setting of vascular insufficiency. Several molecular theories exist as to its origin, but no clear etiology is known. An isolated case report describes treatment of the disorder on the breast with isotretinoin, however, the ultimate cosmesis of this treatment modality was suboptimal due to diffuse scarring and dispigmentation at the completion of therapy. Another case report relates successful surgical management of diffuse dermal angiomatosis on the abdomen via panniculectomy, however there are no reports of reduction mammplasty for the treatment of this condition on the breasts.

Conclusion: Reduction mammaplasty may provide definitive treatment for this rare, yet troubling, disorder.