Accessory Axillary Breast Excision with Liposuction Using Minimal Incision: A Preliminary Report

Two-Stage Surgical Management of Accessory Breast Tissue With Pedicled Breast Tissue: A Case Report of Asymmetry Correction

ABSTRACT

Accessory breast tissue is a relatively common variant of ectopic breast tissue. It defines a tissue that can be seen in conjunction with a nipple, areola, and underlying glandular tissues and can develop in addition to the normal breast tissue. While swelling may be accompanied by symptoms such as pain that worsens with the menstrual period, lactation, and limitation of shoulder joint movements, aesthetic concerns also constitute an important part of the surgical needs of patients. An 18-year-old patient without any known comorbidities attended because of a developmental disorder in her left breast that has existed since birth and an accessory breast tissue containing the nipple and areola in the upper-outer quadrant of the left breast. The surgical aim was to excise the patient's accessory breast tissue and ensure symmetry, and a two-stage surgical intervention was planned. In the first stage, the accessory breast tissue in the upper-outer quadrant of the breast was transposed preserving the 2nd and 3rd Internal Mammary Artery-based perforators by passing it through a subcutaneous tunnel and folding it in its ideal place. At second stage, the reduction mammoplasty surgery was performed on the right breast to ensure symmetry with the left breast, and resection was performed on the nipple in the middle lower quadrant of the left breast. At the end, acceptable symmetry and patient satisfaction were achieved.

Redefining the Axillary Aesthetic: Surgical Management of Axillary Tissue Hypertrophy

Background and Objectives: Axillary tissue hypertrophy consists of ectopic breast tissue and occurs in up to six percent of women. Women complain of pain, interference with activity, and dissatisfaction with appearance. While it is recommended that accessory breast tissue be removed via surgical excision, there is lack of consensus on the best technique for the surgical management of axillary tissue hypertrophy. In this study, the senior authors (BC and NT) review outcomes and complications as they pertain to the surgical treatment of axillary tissue hypertrophy and axillary contouring. Materials and Methods: A retrospective review of all patients (n = 35), from two separate institutions, who presented with axillary tissue hypertrophy between December 2019 and August 2021 was conducted. All patients underwent a technique that included direct crescentic dermato-lipectomy and glandular excision with axillary crease obliteration. Tissue was sent for histological analysis after removal. During a six-month follow-up period, all patient outcomes were recorded. Results: The authors treated 35 women with axillary tissue hypertrophy. All patients complained of aesthetic deformity with significant discomfort leading to the desire for surgery. Histologically, all specimens contained benign breast and adipose tissue. Hypertrophic scarring, seroma, and axillary cording were noted complications. Conclusions: Detailed is the surgical management and optimal technique that can be used to treat both adipose and fibroglandular axillary tissue hypertrophy while simultaneously providing a favorable axillary aesthetic.

Treatment Options for the Clinical Management of Axillary Breast Tissue

Background

Axillary breast tissue includes any combination of fat, nipple, areolae, and glandular tissue alongside breasts and affects 2%-6% of women and 1%-3% of men. Patients may experience functional and/or cosmetic concerns due to axillary breast tissue. There are nonsurgical options for its removal, such as CoolSculpting and Kybella, and surgical options such as liposuction, BodyTite liposuction, and excision. Determining which technique to use in each case is critical in achieving an excellent outcome. Currently, there are no established treatment algorithms for the removal of axillary breast tissue.

Methods

A retrospective review between January 1, 2013, and June 20, 2022, was performed. Data that were extracted included age, BMI, date of procedure, procedure, fat suctioned, tissue excised, and follow-up period. The authors analyzed outcomes and formulated a treatment algorithm based on tissue type (fat versus glandular), amount of tissue excess, skin laxity, and accessory nipple presence.

Results

A total of 43 patients (83 axillae) met our inclusion criteria and were included in our analysis. All patients were female with a mean age of 35.5 ± 10.9 years, a mean BMI of 23.0 ± 3.1, and a mean follow-up period of 8.8 ± 11.1 months. For inclusion, patients had to have undergone CoolSculpting, liposuction, BodyTite liposuction, liposuction with excision, or excision alone. All patients tolerated the procedures well and reported no serious complications.

Conclusions

Nonsurgical and surgical removal of axillary breast tissue is safe and effective. The algorithm presented can be utilized by plastic and reconstructive surgeons to ensure optimal results for axillary breast tissue removal.

Axillary ectopic breast tissue in the adolescent

AIM

Ectopic breast tissue (EBT) includes a spectrum of disease that entails other entities based on the presence of glandular tissue, nipple, or areola. The diagnosis in adolescents is infrequent.

METHODS

A retrospective study was performed including girls with axillary EBT (class IV or V of Kajava's Classification) operated in 2006-2020. Imagining studies, clinical and surgical reports, and histopathology were reviewed.

RESULTS

Eleven girls from 13 to 16 years old were included. Two patients (18.2%) presented bilateral EBT. The most frequent clinical manifestation was 2-5 cm mass (100%), associating cyclic pain with menstruation (45%) and fluctuating volume (36%). Bilateral axillary ultrasonography allowed preoperative diagnosis. All of them were treated by open excision, through small incisions located in an axillary y fold. Clinical and aesthetic results were self-assessed as "very good", with normalization of the axillary y hollow and imperceptible scars. No recurrences were observed after one year of follow-up. An immediate postoperative hematoma was reported, which did not require drainage. Histopathology showed mature breast tissue without atypia.

CONCLUSIONS

Axillary accessory breasts must be included in differential diagnosis of pediatric axillary masses. Bilateral ultrasonography is recommended for the preoperative diagnosis. Excision through minimal incision at this age seems to be safe and effective.

Efficacy of Two-Step Surgery on Severely Protruding Axillary Accessory Breast: First-Step Mammary Gland Excision Followed by Second-Look Redundant Skin Excision

BACKGROUND

Symptoms of axillary accessory breasts (AABs) vary among patients. Mildly protruding AABs do not require skin excision, whereas severely protruding AABs might. We report a novel technique that includes mammary gland excision followed 6 months later by second-look redundant skin excision, if necessary.

OBJECTIVES

We aimed to evaluate the efficacy of this two-step surgical approach and compared it with one-step en bloc resection in severely protruding AAB patients.

METHODS

This retrospective study included 834 women who underwent AAB excision during 2017-2019. AABs were classified according to their external appearance: protruding, palpable accessory breast at an obtuse angle (class I) or an acute angle with accompanying skinfold (class II). Class II was further divided according to the excision technique: one-step en bloc resection (n = 36) or two-step resection (n = 42). Patients completed post hoc satisfaction surveys evaluating appearance, axillary pain, and scar, 6 months postoperatively.

RESULTS

There were 204 class II patients and 168 patients who underwent a two-step approach; 42/168 underwent second-look skin excision, and 126/168 underwent one-step gland excision exclusively. The remaining 36 patients underwent one-step resection. Scars measured 4.3 cm in the second-look group versus 6.4 cm in the one-step group (P < 0.000). Overall satisfaction scores were higher in the second-look group versus the one-step group (13.6 vs. 12.3, respectively; P < 0.000).

CONCLUSIONS

For severely protruding AABs, mammary gland excision with skin preservation comprises the first operation, and second-look skin excision can be considered 6 months later. This procedure avoids overtreatment and potentially increases patient satisfaction compared with one-step en bloc excision.

LEVEL OF EVIDENCE IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Axillary Accessory Breast: Optimal Time for Operation

BACKGROUND

Accessory breasts are usually located in the axilla. Symptoms associated with an axillary accessory breast (AAB) may newly develop or worsen after pregnancy. After childbirth, AAB engorgement and hyperplasia may occur due to milk formation. We evaluated the optimal time for AAB excision and assessed variations in clinical presentations and surgical outcomes associated with pregnancy.

METHODS

In total, 540 women whose symptoms began from puberty and underwent AAB excision were retrospectively analyzed. Group 1 comprised 416 patients who underwent operations before pregnancy, and Group 2 comprised 124 patients who underwent operations after childbirth. AABs were classified according to the Damsoyu-Lee (DL) classification. Satisfaction was measured by pain and cosmesis 3 months postoperatively.

RESULTS

Group 2 had more patients with severe symptoms [DL class II (n = 8, 6.5%) and III (n = 15, 12.1%)] than Group 1 (p = 0.049). The specimen weight and liposuction volume were greater in Group 2. The reoperation rate was also higher in Group 2 [loosening skin excision (n = 4, 3.2%) and remnant gland excision (n = 3, 2.4%)] (p = 0.032). In Group 2, 31 (25%) patients had AAB engorgement after childbirth and 7 (5.6%) had milk secretion from the accessory nipple after childbirth. The overall satisfaction score was lower in Group 2 than 1.

CONCLUSIONS

Pregnancy may cause accessory breast gland hyperplasia. After childbirth, symptoms such as AAB engorgement and milk secretion from the accessory nipple may occur. The optimal timing for operation for AAB appears to be before the onset of pregnancy because of lower reoperation rates and greater patient satisfaction.

LEVEL OF EVIDENCE IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .