Plastic & Reconstructive Surgery:
Accessory Breast Tissue in the Axilla: Classification and Treatment
Bartsich, Sophie A. M.D.; Ofodile, Ferdinand A. M.D.
Harlem Hospital Center; New York, N.Y.
Correspondence to Dr. Bartsich; 300 East 59th Street, Apt. 805; New York, N.Y. 10022; firstname.lastname@example.org
Axillary breast tissue affects between 2 and 6 percent of women.1 The variability of presentation and the possibility of other disease make this problem clinically challenging, and although it is a well-known entity, there is no established classification system to guide its management.2 Determining which surgical technique to use is critical to achieving an optimal outcome.
In cases where the excess tissue is contiguous with the normal breast, with similar consistency on palpation, suction lipectomy will often suffice for recontouring the axilla, and it is preferable to direct excision. Although this approach does not provide a tissue sample, it has the advantages of smaller incisions, feathering of tissue removal for a smoother contour, and the creation of less dead space. In cases where there is a firm core of palpable glandular tissue within the mass, a combination of direct excision and suction lipectomy is necessary. Failure to excise the glandular elements may result in a residual mass and the necessity for a secondary procedure.
Direct excision of larger masses results in long unsightly scars, disruption of numerous lymphatic channels, and a significant amount of axillary dead space. This may result in postoperative seroma formation and prolonged lymphatic drainage into the cavity.
Nine patients were treated for excess axillary breast tissue over a 6-month period. The average age at presentation was 42 years, and eight patients presented with bilateral symptoms. None of the patients had any chronic medial illness or a history of breast disease. In total, 17 axillae were treated, including two type I, four type II, five type III, and six type IV axillae. Two axillae were treated with liposuction alone, 10 were treated with direct skin and tissue excision, and five underwent a combination of suction lipectomy and skin excision. The mean follow-up was 6 months.
All excised tissue revealed benign breast tissue, and skin specimens were similarly free of disease. One patient with type I axillary breast tissue who was treated with liposuction alone presented postoperatively with a remaining core of breast tissue. One patient treated with direct tissue excision presented with a postoperative seroma that required serial drainage followed by percutaneous drain placement for 2 weeks until drainage resolution. The most prevalent source of postoperative dissatisfaction was unsightly scarring and prolonged discomfort at the incision site (Table 1).
Based on our experience treating excess axillary breast tissue, we devised a simple treatment algorithm for this problem whereby distinct excess parenchymal tissue, excess axillary fat, and axillary skin are treated as separate entities. Morbidity is minimized through the use of closed suction drains, well-designed incisions, and direct excision of tissues that are not amenable to treatment by means of suction lipectomy.
The most common complaints after removal of excess axillary breast tissue include incomplete excision, seroma, pain, intercostal nerve injury, ugly scarring, and contour deformity.3,4 Many of these complications can be avoided with careful planning, attention to contour, and meticulous dissection.
Neither author has any financial interests to disclose.
Sophie A. Bartsich, M.D.
Ferdinand A. Ofodile, M.D.
Harlem Hospital Center
New York, N.Y.
1. Harris JR, Lippman ME, Morrow M, Osbourne CK. Diseases of the Breast. 2nd ed. Philadelphia: Lippincott Williams & Wilkins; 2000.
2. Lesavoy MA, Gomez-Garcia A, Nejdi R, Yospur G, Syiau TJ, Chang P. Axillary breast tissue: Clinical presentation and surgical treatment. Ann Plast Surg. 1995;35:356–360.
3. Down S, Barr L, Baildam D, Bundred N. Management of accessory breast tissue in the axilla. Br J Surg. 2003;90:1213–1214.
4. Greer KE. Accessory axillary breast tissue. Arch Dermatol. 1974;109:88–89.
Viewpoints, pertaining to issues of general interest, are welcome, even if they are not related to items previously published. Viewpoints may present unique techniques, brief technology updates, technical notes, and so on. Viewpoints will be published on a space-available basis because they are typically less timesensitive than Letters and other types of articles. Please note the following criteria:
* Text—maximum of 500 words (not including references)
* References—maximum of five
* Authors—no more than five
* Figures/Tables—no more than two figures and/or one table
Authors will be listed in the order in which they appear in the submission. Viewpoints should be submitted electronically via PRS' enkwell, at www.editorialmanager.com/prs/. We strongly encourage authors to submit figures in color.
We reserve the right to edit Viewpoints to meet requirements of space and format. Any financial interests relevant to the content must be disclosed. Submission of a Viewpoint constitutes permission for the American Society of Plastic Surgeons and its licensees and assignees to publish it in the Journal and in any other form or medium.
The views, opinions, and conclusions expressed in the Viewpoints represent the personal opinions of the individual writers and not those of the publisher, the Editorial Board, or the sponsors of the Journal. Any stated views, opinions, and conclusions do not reflect the policy of any of the sponsoring organizations or of the institutions with which the writer is affiliated, and the publisher, the Editorial Board, and the sponsoring organizations assume no responsibility for the content of such correspondence.
This article has been cited 1 time(s).
Aesthetic Plastic SurgeryEctopic Breast Cancer: Case Report and Review of the LiteratureAesthetic Plastic Surgery
©2011American Society of Plastic Surgeons