What is the recommended treatment for accessory breast tissue in the axilla?

Treatment of Accessory Breast Tissue in Axilla

Surgical excision is the recommended treatment for accessory breast tissue in the axilla, addressing both cosmetic concerns and minimizing potential cancer risks. 1

Clinical Presentation and Diagnosis

• Accessory breast tissue is most commonly located in the axilla, though it may be present anywhere along the milk line 2
• Symptoms may include:
  • Discomfort during menstruation 3
  • Anxiety and cosmetic concerns 3
  • Pain or restriction of arm movement 3
  • Swelling that may mimic axillary lymphadenopathy 4

Evaluation Process

• Complete clinical evaluation to assess for other sites of adenopathy and potential non-breast etiologies 4
• Age-appropriate diagnostic imaging:
  • Ultrasound with mammogram for patients ≥30 years of age 4
  • Ultrasound alone for patients <30 years of age 4
• Core needle biopsy for palpable axillary mass that appears suspicious on imaging 4

Treatment Options

Surgical Approaches

1. Excision:

   • Complete surgical removal of accessory breast tissue 3
   • Particularly indicated when the tissue causes significant symptoms or when there are concerns about malignancy 1
   • Can be performed through minimal incisions placed in natural skin folds to minimize visible scarring 5

2. Liposuction:

   • Effective for cases with predominant fatty component 3
   • May be used alone or in combination with excision 3

3. Combined approach:

   • Liposuction with excision through minimal incision in the axillary fold 5
   • Provides good cosmetic results with less conspicuous scarring 5
   • Shown to have high satisfaction rates (95.65% in one study) 6

Management Algorithm

1. For asymptomatic patients:

   • Observation is acceptable if the patient is not bothered by the condition 2
   • Regular follow-up to monitor for changes 4

2. For symptomatic patients:

   • Surgical intervention is recommended 3
   • Choice between excision, liposuction, or combined approach depends on:
     • Amount of glandular tissue vs. fat 3
     • Patient's cosmetic concerns 3
     • Surgeon's expertise 5

3. For patients with concomitant breast hypertrophy:

   • Consider simultaneous reduction mammaplasty and removal of accessory breasts 3

Postoperative Care

• Compression dressing for 1-2 weeks postoperatively 5
• Sports bra for 1-2 months after removal of the dressing 5
• Monitor for potential complications:
  • Seroma (most common complication, 11.27% in one study) 6
  • Hematoma 6
  • Infection 6

Special Considerations

• If malignancy is suspected in the accessory breast tissue, follow the NCCN Guidelines for Breast Cancer for management of the axillary mass 4
• For patients with accessory breast tissue discovered during evaluation for breast cancer, ensure proper staging and treatment according to breast cancer guidelines 2
• In cases where accessory breast tissue is found with nipple or nipple-areolar complex, complete excision is generally recommended for both cosmetic and diagnostic purposes 6

Common Pitfalls to Avoid

• Misdiagnosing accessory breast tissue as lymphadenopathy or breast cancer recurrence 2
• Inadequate excision leading to recurrence of symptoms 5
• Overly aggressive excision resulting in contour deformities 5
• Failure to place incisions in natural skin folds, resulting in visible scarring 5