Gigantomastia, a rare condition of uncertain etiology is characterized by incapacitating breast enlargement. This condition can lead to local breast necrosis, infection, and ulcers. The first case of gravidic gigantomastia was reported in 1648 and since then less than 100 cases have been reported in the literature. It is estimated that the incidence of this disorder is between one in 28000 and one in 100,000 pregnancies. We present an unusual case of gigantomastia in a 23 year old gravida 1, with rheumatoid arthritis, and lupus. Her pregnancy was complicated by pain, ulceration, and skin necrosis. Failing nonoperative techniques, reduction mammoplasty resulted in primary wound healing. Gigantomastia complicated by these autoimmune disorders complicates the treatment of this disorder and may dictate earlier surgical treatment of these patients.