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Gestational gigantomastia is a very rare disorder characterised by massive, bilateral breast enlargement during pregnancy. Clinically, it is characterised by rapid breast enlargement associated with severe mastodynia, back and shoulder pain, and erythema of the skin. In its most severe forms, it can lead to ulceration, necrosis, haemorrhage, or septicaemia. The underlying pathophysiology is not completely understood, but is thought to be multifactorial, involving hormonal hypersensitivity and autoimmune mechanisms. Histopathological confirmation is necessary for definitive diagnosis because its clinical presentation can closely mimic that of inflammatory breast carcinoma or other malignant neoplasms. We report a case of a 28-year-old primigravida who presented at 24 weeks of gestation with progressive bilateral breast enlargement that reached its maximal extent at 36 weeks and caused significant functional impairment. On clinical examination, there was symmetrical breast hypertrophy with diffuse erythema and a marked peau d'orange appearance. Breast ultrasound revealed glandular hypertrophy with ductal ectasia and marked oedema. No suspicious focal lesions were seen. Hormonal and immunological workup was normal, and skin and glandular biopsy showed benign hyperplasia without atypia. Throughout the pregnancy, conservative management with analgesics and postural support was continued until an uncomplicated vaginal delivery at 39 weeks of gestation. Cabergoline was then administered to suppress lactation. Given the absence of spontaneous regression of the breasts, a multidisciplinary decision was taken to perform a bilateral reduction mammoplasty at 12 months postpartum. This case demonstrates the phenotypic variability of gestational gigantomastia that may present without any preceding breast pathology. In severe cases, surgical treatment (reduction mammoplasty or bilateral mastectomy with delayed reconstruction) is the mainstay of treatment, and bromocriptine is the best-established medical alternative, but with variable success. Coordinated multidisciplinary care is essential to optimise patient outcomes and minimise life-threatening complications.