Reconstr. Excess overlying skin should be tissue is the most common type of polymastia accounting Accessory breast is an infrequent clinical finding, with for 60 -70% of all ectopic breast tissue (3). Management of the axilla must also be considered; when a diagnosis of breast cancer is made, axillary staging is performed by ultrasound and cytology or core biopsy . The present trend is to remove the axillary accessory breast tissue with excision, liposuction or both. Class III consists of areola and glandular tissue but no nipple. Accessory axillary breast breasts arranged in neat rows on their torso (1). developing in the accessory breast.7,8 Excision of ectopic axillary breast tissue may be required for diagnosis, treatment of symptoms, or cosmesis 2 and is the definitive treatment for the above . Whereas in the past, radical axillary clearance was the norm, today, sentinel lymph node (SLN) biopsy is favored if the axilla is clinically negative ( 43 ). We named supernumerary breast as accessory breast. 128(1), 35e-36e (2011). Case Presentation. Most common pathology is invasive ductal carcinoma (50-75%). Thus, we aim to report long-term outcomes in five cases treated at our institution. Ectopic breast cancer represents an uncommon disease accounting for about 0.3% of all breast neoplasms, limiting the available evidence. It is a benign lesion that indicates incomplete involution of the milk line during embryogenesis. AB was classified by Kajava in 1915 [ 6] as follows: Class I consists of a complete breast with nipple, areola, and glandular tissue. Neki et al. The embryonic milk line is the line . Treatment Options by Tissue Type. The treatment of choice for symptomatic accessory axillary breast tissue is surgical excision. Removal of the tissue will relieve the physical discomfort and also confirms the diagnosis. Liposuction for accessory axillary breast tissue is now an available mode of treatment for smaller sized tissues with a mainly fatty element. Plast. Congenital problems and aberrations of normal breast development and involution. In our series, all the patients had only breast tissue. Breast cancer is one of the most common cancers in women. Qian JG, Wang XJ, Yu AR, Zhou FH. The remaining 13% of the aberrant sites include face, posterior neck, chest . Primary ectopic breast carcinoma (PEBC) is a very rare and progressive case most commonly encountered in the advanced stage. Even in larger accessory breasts it can be combined with excision and makes identification of the plane between normal and accessory breast tissue easier to find. Supernumerary Nipple Classification9 Classification by Kajava Description 1 Complete SN: nipple, areola, and glandular breast tissue; known as polymastia 2SN: nipple and glandular tissue without areola 3 SN: areola and glandular tissue without nipple Background. Also known as ectopic breast tissue, accessory breast tissue can be found in up to 6% of the population [ 2 ]. a Incision line in the axilla.b The axilla after a tumescent solution was executed.c Liposuction below the accessory breast tissue.d Dissection between accessory breast tissue and subcutaneous fat.e Cutting from the center of accessory breast tissue outward.f Pulling the removed part of accessory breast tissue out of the . Some breast tissue extends into the armpit (axilla). Embryologically, EBT originates from ectoderm thickening and it may occur along the milk line within the area from the axilla to the external . Plast Reconstr Surg. AJR Am J Roentgenol 202(5):1157-1162 We present a rare case of carcinoma developing in an accessory breast. doi: 10.1097/PRS.0b013e3182173f95. De Cholnoky T. Accessory breast tissue in the axilla. Other differential diagnoses for an axillary mass include axillary lymphadenopathy, lipoma, abscess, seroma, hidradenitis and skin lesions [ 4 ]. They usually have a nipple and areola and a separate duct system from that of the normal breast. Congenital problems and aberrations of normal breast development and involution. Accessory breast tissue excision with liposuction using minimal incision. In recent years, many affected women have had a plastic surgery . This is known as the axillary tail of the breast. a Preoperative frontal appearance with arms adducted. Excess Fat. Background. Treatment. Removal of the tissue will relieve the physical discomfort and also confirms the diagnosis. We present a case of a 41-year-old woman with an accessory breast in the left inframammary fold, which . Class II consists of nipple and glandular tissue but no areola. Surg. d Accessory mammary gland tissue was removed through the 1-cm incision. . This is important because a breast cancer can . Supernumerary nipple is a common, minor birth defect that consists of an extra nipple (s) and/or related tissue, in addition to the two nipples that normally appear on the chest. Axillary breast is but one of the many sites where accessory breast tissue can be present. Down S, Barr L, Baildam AD, Bundred N. Management of accessory breast tissue in the axilla . Breast cancer in accessory breast tissue is very rare. If required, surgical treatment is the option for cosmetic and physical discomfort reasons. Accessory breast is a congenital atavism condition. Most younger people who have been born female have dense breasts, because they have more glandular tissue than fat in them. Ectopic breast tissue (EBT), also known as accessory breast tissue, includes both supernumerary and aberrant breast tissue [] and is the most common congenital breast abnormality [].EBT develops as the result of the incomplete embryologic regression of the mammary ridge, which extends bilaterally from the anterior axilla folds to the inguinal folds, and is encountered in 2% to . The final classification was pT1cN0(sn)M0: stage IA. b Postoperative frontal view 2 weeks postoperatively. The final classification was pT1cN0(sn)M0: stage IA. Accessory . Bartsich SA, Ofodile FA. CAS Article Google Scholar DeFilippis EM, Arleo EK (2014) The ABCs of accessory breast tissue: basic information every radiologist should know. In case of a symptomatic patient with accessory breast tissue in the axilla, surgical excision of the mass is done to relieve the physical discomfort caused due to the large masses of accessory breast tissue. 1. Most supernumerary nipples do not cause symptoms or complications. Gilmore et al. Accessory nipples vary and are usually just rudimentary but can include glandular tissue (accessory breast). 2 determining which surgical technique to use is critical … In conclusion, liposuction is therefore a simple and effective treatment for chest submammary accessory breast. A cutaneous and/or subcutaneous lesion except for proper breast tissue on the milk line, or mammary ridge from axilla to groin may be an accessory breast tissue. Bartsich SA, Ofodile FA. A supernumerary nipple is distinct from: Polythelia, which is the presence of supernumerary nipples without accessory glandular tissue Accessory breast tissue derives from a failure of the primitive mammary tissue to regress after development of the mammary ridge in the thoracic area at week 7 of gestation . Ectopic breast tissue is present in 2-6% of women. Most of the defects appear where the embryonic milk-line was located, but cases have been reported of ectopic breast tissue in other parts of the body, including the face, scapula, limbs or . A tail of breast tissue called the "axillary tail of Spence" extend into the underarm area. It affects 2-6% of females and 1-3% of males but there is no definite incidence number for accessory breast malignancy; furthermore, reports for accessory breast cancer only include case reports and case series. The chest submammary accessory breast consisted mainly of fatty tissue rather than mammary gland tissue; thus, chest submammary accessory breasts are painless and are treated purely for cosmetic reasons. accessory breast tissue in pregnancy and her fetus will have an excellent overall prognosis with supportive treatment. 2011 Jul;128(1):35e-6e. According to the literature, the incidence of these anomalies ranges between 1% and 6%, being more common among blacks, Jews, and Japanese. Plast Reconstr Surg 128(1):35e-e36. However, the classical . On examination, there was a well-developed nipple areola complex in the right axilla overlying a hard, fixed 5×3 cm lump. Letrozole 2.5 mg/day will be administered for 5 years as adjuvant hormonal therapy. seeking excision of accessory breast tissue. Accessory breast tissue in the axilla: classification and treatment Plast Reconstr Surg. Patient underwent excision biopsy (Figure 3).Per operative finding was a subcutaneously located lesion which was excised. 128(1), 35e-36e (2011). J Plast Reconstr Aesthet Surg, 61(8):968-970, 15 Apr 2008 Cited by: 1 article | PMID: 18417436 A combination of surgery for the glandular element and liposuction of the fatty element has been described. axillary breast tissue affects between 2 and 6 percent of women. Supernumerary nipples are common minor congenital malformations that consist of nipples and/or related tissue in addition to the nipples normally appearing on the chest. Background. Bartsich SA , Ofodile FA Plast Reconstr Surg , 128(1):35e-36e, 01 Jul 2011 Accessory nipples in the bra line can be excised if they cause irritation. Bartsich SA, Ofodile FA (2011) Accessory breast tissue in the axilla: classification and treatment. The treatment of choice for symptomatic accessory axillary breast tissue is surgical excision. there are many possible treatments to correct polymastia; however, it is generally recommended that accessory breast tissue be excised. They are often asymptomatic but require treatment when symptomatic or if they harbour malignancy. A Plast. accessory breasts, and in some cases it is the only treatment required. The axillary polymastia is a variant of ectopic breast tissue (EBT). Surg. 1. Polymastia, or the presence of supranumerary breasts, occurs in 2-6% of the female population, the spectrum of the disorder ranging between a small mole and a fully functional ectopic breast. Accessory breast tissue is defined as the presence of extra breast tissue in addition to normal breast tissue [ 4 ]. Reconstr. Ectopic breast tissue can undergo the same physiological and pathological processes as the normally located breast. Surg. Most of the cases develop from the ectopic/accessory breast tissue (EBT). The malignancy in accessory breast tissue is considered as primary breast cancer. Accessory breast tissue in the axilla: classification and treatment. Fibroadenoma measuring 2.5 cm in an axillary accessory breast (AAB) in a 38-year-old woman who underwent surgery. Accessory breast tissue may arise anywhere along the mammary line because of the failure of complete maturation during embryogenesis. The chest submammary accessory breast consisted mainly of fatty tissue rather than mammary gland tissue; thus, chest submammary accessory breasts are painless and are treated purely for cosmetic reasons. In case of a symptomatic patient with accessory breast tissue in the axilla, surgical excision of the mass is done to relieve the physical discomfort caused due to the large masses of accessory breast tissue. Introduction. The incidence of fibroadenoma developing in ectopic breast is reported as a rare entity, the most common being the carcinoma. In these cases, the skin is not cut out, and scarring is minimal. The incidence of supernumerary breast and ectopic breast tissue around the world is 1-6% (Rizvi, G. et al., 2012). Accessory breast tissue in the axilla: classification and treatment. Letrozole 2.5 mg/day will be administered for 5 years as adjuvant hormonal therapy. Of all the accessory breast tissues, 20% are axillary [ 3 ]. A supernumerary nipple is a minor malformation of mammary tissue resulting in extra nipple (s) and/or associated tissue. When the nipple is absent, the presence of the accessory breast tissue is difficult to identify. Reconstr. Accessory breast tissue is rare, affecting about 2-6% of the general population and it is usually bilateral. 1, 7 sadove and van aalst 8 reported that when compared to other congenital and acquired breast anomalies, correction of polymastia with breast reduction techniques required the least number of operations per … Accessory mammary tissue in the axilla behaves like anatomical breast, their physiology and pathologies are similar and include pain, inflammation, fibroadenoma and carcinoma [ 4 ]. Accessory breast tissue can be found anywhere along the thoracoabdominal region of the milk line the embryologic mammary streak but are most frequently found in the axilla and may occur bilaterally. The accessory breast was classified by Kajava et al. Down S, Barr L, Baildam AD, Bundred N. Management of accessory breast tissue in the axilla . Second, the presence of an abnormal lymph node can be related to an underlying . Of all cases of breast cancer, 0.3-0.6% of cases are ectopic [].Although accessory breast cancers (ABCs) mostly occur in the axillary area [], they can be found in other areas, for example, scapula, thigh, and labia majora [].We found an exceptionally rare case of ABC where a subcutaneous mass without any overlying skin changes was . Class IV consists of glandular tissue only. Small stab incisions can be made and a thin canula inserted, allowing suction of the fat cells for a minimally invasive treatment. 1. Supernumerary nipple is also known as accessory nipple, ectopic nipple or extra nipple. Accessory breast tissue in the axilla: classification and treatment. A new algorithm has been proposed by American Association of Plastic Surgery in 2011 for the treatment of Axillary Breast tissue using combination of surgical excision and If the extra tissue in your armpit is mostly fat, then it may be easily removed with liposuction alone. 1 These axillary masses are thought to be caused by remnant accessory breast tissue and an excessive buildup of dermafat. 1 Treatment modalities thus far include direct excision as well as liposuction.1, 2, 3 While direct excision allows for accessible and adequate tissue resection, it results in longer scars and the creation of dead space. reported a case of Class 1 axillary breast tissue in a 32-year-old female with an axillary pendulous mass of 6.5 years duration which had a well-formed nipple and areola. We report the unusual case of a 50-year-old lady with . doi: 10.1097/PRS.0b013e3182173f95. Carcinomas of primary accessory breast tissue are rare, comprising 0.3-0.6% of all breast cancers and occur most commonly in the axilla. Some cancers or other abnormalities can consequently develop in the axilla and can be missed if the axilla is not scanned . The accessory breast tissue most commonly (approximately 67 %) occurs in the thoracic or abdominal pathway of the milk line, more commonly just below the inframammary crease. 2.3. About 2-6% women have this condition and 20% of all accessory breasts occur in axilla [ 5, 6 ]. Epidemiology First, accessory axillary breast tissue is present in 0.6%-6% of the general population (7,8). The most common location is axilla (60-70%) although. Although this finding has been reported in a variety of clinical journals, such as Radiology and Human Pathology, it . in 1915; based on composition of the aberrant tissue [ 6, 7 ]. The principles of postoperative treatment are the same as for anatomic breast carcinoma [ 18 ]. there are many possible treatments to correct polymastia; however, it is generally recommended that accessory breast tissue be excised. Bartsich SA, Ofodile FA (2011) Accessory breast tissue in the axilla: classification and treatment. In conclusion, liposuction is therefore a simple and effective treatment for chest submammary accessory breast. The accessory breast tissue responds in the same way as normal . Cosmesis is the main indication in the majority of cases [ 5 ]. Accessory axillary breast tissue is present in approximately 2% to 6% of women. The extra breast tissue can be present in developed form or any combination of glandular tissue, nipple and areola (Kajava classification). NY State Med J.1951;51:2245-2248. Abstract. Surgical correction of axillary accessory breast tissue: 12 cases with emphasis on treatment option. 5 In the general population, about 2%-6% of the females and 1%-3% of males have accessory breast tissue, which is usually found (67%) along the thoraco-abdominal region of the milk line. Accessory breast tissue can occur anywhere between the axilla and the groin. Plast Reconstr Surg 99(2):386-393 Bartsich SA, Ofodile FA. On investigation, core biopsy revealed poorly differentiated carcinoma of the breast. Down S, Barr L, Baildam AD, Bundred N. Management of accessory breast tissue in the axilla . Our Tunisian patients' median age was 48 years (33-60 years), and the median follow-up was 8 years (4-10 . 12. The highest incidence occurs in the Japanese population [ 3 ], with the lowest incidence in white individuals [ 4 ]. Accessory breasts, also known as polymastia, supernumerary breasts, or mammae erraticae, is the condition of having an additional breast.Extra breasts may appear with or without nipples or areolae.It is a condition and a form of atavism which is most prevalent in male humans, and often goes untreated as it is mostly harmless. Accessory breast tissue - the presence of a nipple, areola or glandular tissue in addition to the normal pair of breasts - is an uncommon, but potentially painful and embarrassing, condition. BMJ 309(6957), 797-800 (1994). Accessory breast tissue is usually found in the axilla and supernumerary or accessory nipples are usually seen below the breast and above the umbilicus. A cutaneous and/or subcutaneous lesion except for proper breast tissue on the milk line, or mammary ridge from axilla to groin may be an accessory breast tissue. Accessory breast tissue in the axilla: classification and treatment. Accessory breast tissue is defined as "residual [breast] tissue that persists from normal embryologic development" [ 1 ]. An axillary accessory breast (AAB) occurs in 2-6% of women [], and some patients require treatment for associated cyclic axillary pain or aesthetic concerns [2, 3].Rarely, patients present with a chief complaint of a palpable nonpainful axillary mass, which has been described in case reports as a fibroadenoma [].Periodic enlargement of an AAB and cyclic pain are the primary . accessory breast tissue in pregnancy and her fetus will have an excellent overall prognosis with supportive treatment. 2011 Jul;128(1):35e-36e. This normal variant can present as a mass anywhere along the course of the embryologic mammary streak (axilla to the inguinal region). Liposuction is also valuable in helping to define the planes between accessory breast tissue and the underlying axilla. 2. Plast. A Supernumerary nipples are located along the embryonic milk lines. 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. For adequate treatment of patients with breast cancer, mastologists should have a complete understanding of the anatomy of the thoracic wall, axilla and breast. The incidence is around 6%. A prominent or sagging axillary mound, appearing as a mass in the axilla, is the most frequently encountered form of polymastia, or ectopic breast. The true inci- a reported incidence of 0.4 -6% (2), yet it is a concern in dence of ectopic breast tissue . Surgical Treatment of Axillary Accessory Breasts Article Mar 2010 AM SURGEON Fatih Aydogan Semih Baghaki Varol Celik Hilal Unal View Show abstract MRI Appearance of Accessory Breast Tissue: A. BMJ 309(6957), 797-800 (1994). Accessory Axillary breast can be fairly common occurring in 2-6% of women. Two main reasons might support this approach. Congenital problems and aberrations of normal breast development and involution. This may be complicated by seroma and haematoma formation. Plast Reconstr Surg 128(1):35e-36e. This anatomically superficial location of the lesion explains why this is an example of ectopic breast tissue rather than an extension of breast parenchyma into the axilla (axillary tail of Spence) which is located deep. Accessory breast tissue, also known as polymastia, is a relatively common congenital condition in which abnormal accessory breast tissue is seen in addition to the presence of normal breast tissue. Cosmesis is the main indication in the majority of cases. The patient presented with a progressive lump in her right axilla for 1 year. BMJ 309(6957), 797-800 (1994). The breast tissue extends horizontally (side-to-side) from the edge of the sternum (the firm flat bone in the middle of the chest) out to the midaxillary line (the center of the axilla, or underarm). from their study on a population of American women found that supernumerary nipple and accessory breast tissue were more common in the Native American women than in the non-native women. c The 1-cm incision along the axillary skin crease. Management of accessory breast tissue cancer should follow the recommendations for pectoral breast cancer of parallel TNM classification [2]. It is also known as accessory nipple, ectopic nipple, or extra nipple. CAS Article Google Scholar Lejour M (1997) Evaluation of fat in breast tissue removed by vertical mammaplasty. Developed by renowned radiologists in each specialty, STATdx provides comprehensive decision support you can rely on - Axillary Adenopathy Axillary breast cancer is an under-recognised site of primary breast cancer. Accessory breasts are classically distributed along the embryonic milk line and are most often located in the axilla. 1, 7 sadove and van aalst 8 reported that when compared to other congenital and acquired breast anomalies, correction of polymastia with breast reduction techniques required the least number of operations per … Accessory breast (AB) also known as polymastia or supernumerary breasts is an ectopic breast tissue, it may develop due to an incomplete regression of the embryonic mammary ridge "milk line" which extends from the axilla to the groin [1, 2].It is a rare congenital entity which occurs in 0.4-6% of women, the highest incidence occurs in the Japanese population [3, 4]. 128(1), 35e-36e (2011). Ectopic supernumerary nipples are found beyond the embryonic milk lines. Accessory breast tissue in the axilla: classification and treatment. Most patients with accessory breast tissue are asymptomatic. 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