Accessory Breast Tissue in the Axilla: Classification and Treatment

Abstract

Sir: 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).Table 1: Classification of Excess Axillary Breast Tissue and Management AlgorithmBased 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. DISCLOSURE 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.