Management of Accessory Breast Tissue
Surgical excision is the definitive treatment for symptomatic accessory breast tissue, with liposuction or combined approaches as alternatives depending on tissue composition and patient goals. 1
Indications for Intervention
Accessory breast tissue does not require treatment unless it causes specific problems 1, 2:
- Symptomatic discomfort during menstruation or lactation 1
- Physical limitations including restriction of arm movement 1
- Cosmetic concerns causing patient anxiety 1
- Diagnostic uncertainty when masses develop that could represent pathology 3, 4
- Pain that interferes with daily activities 1
Asymptomatic accessory breast tissue can be observed without intervention 2.
Surgical Treatment Options
Primary Surgical Approaches
Excision is the most common definitive treatment, performed in the majority of cases 1:
- Complete removal of all accessory breast tissue is the goal 1
- The incision should be placed over or close to the tissue and of adequate size to allow removal in one piece 5
- Curvilinear incisions following Langer's lines generally achieve the best cosmetic result 5
- For axillary accessory breasts, the incision placement must balance complete excision with cosmetic outcome 5
Liposuction can be used as an alternative approach 1:
- Appropriate when the accessory tissue is predominantly fatty 1
- May be combined with excision for optimal results 1
Combined excision and liposuction provides flexibility for complex cases 1.
Technical Considerations
The surgical technique should follow established breast surgery principles 5:
- Skin closure should use subcuticular technique to optimize cosmetic results 5
- Preserve subcutaneous tissue with separate closure to improve cosmetic outcome 5
- Meticulous hemostasis is critically important to prevent hematoma formation, which complicates healing and future imaging 5
- Avoid excessive tissue sacrifice while ensuring complete removal 5
- Orient the specimen properly for pathologic examination 5
Concurrent Procedures
When accessory breast tissue coexists with breast hypertrophy, reduction mammaplasty and removal of accessory breasts can be performed simultaneously with no additional morbidity 1. This approach addresses both aesthetic concerns in a single operation 1.
For complex cases requiring symmetry correction, staged procedures may be considered 6.
Critical Diagnostic Caveat
Accessory breast tissue can undergo the same pathological processes as normal breast tissue, including fibroadenoma and invasive carcinoma 3, 4. The incidence of breast cancer in accessory tissue is approximately 6%, with invasive ductal carcinoma being the most common pathology (50-75%) 4.
When Malignancy is Suspected
If a mass develops within accessory breast tissue 3, 4:
- Core biopsy should be performed for tissue diagnosis 4
- Ultrasound evaluation helps characterize the lesion 4
- Multidisciplinary discussion is essential if malignancy is confirmed 4
- Treatment follows standard breast cancer protocols including appropriate surgical margins, sentinel lymph node evaluation, and adjuvant therapy as indicated 4
Special Populations
High-risk women may be considered for prophylactic excision of accessory breast tissue, as this tissue is typically outside the field of screening breast examination 4. This prevents future diagnostic challenges and eliminates malignant potential in tissue that would otherwise go unmonitored 4.
Common Pitfalls to Avoid
- Do not dismiss axillary masses in patients with history of breast cancer as recurrence without tissue diagnosis, as they may represent benign accessory breast pathology 2
- Avoid incomplete excision that leaves residual tissue causing persistent symptoms 1
- Do not reapproximate tissue in a way that appears adequate when the patient is supine but causes distortion when upright 5
- Prevent hematoma formation through meticulous technique, as this complicates both physical examination and imaging interpretation long-term 5