What is Accessory Axial Breast Tissue?

If you notice an extra piece of breast tissue on your left axilla, you may have accessory axillary breast tissue. This tissue has different properties from ipsilateral breast tissue. It is non-tender, rubbery, firm, and not contiguous with the ipsilateral breast tissue.

Non-tender

It’s rare to have accessory breast tissue. However, when it does develop, it can be extremely painful and embarrassing. One patient had noticed two non-tender axillary breasts on her back, but hadn’t considered removing them. She was concerned about a mass in her midline, which was a sign of an accessory breast, and she wanted to find out what she could do about it.

A 38-year-old woman with no prior medical history presented to her doctor with swellings in both axillary regions nine months earlier. She had previously visited a different hospital for a slight fever and axillary discomfort, but this time, she went in for a biopsy. The pathology report showed that she had a non-tender accessory axillary breast mass.

Rubbery

Although rare, accessory breast tissue is present in about 0.4-6% of women. This type of tissue undergoes all the normal cyclical changes that affect the breast. While these breast tissues can be benign, they can also become malignant, causing fibroadenomas or cancer. The most common type of malignancy in this tissue is invasive ductal carcinoma, while lobular carcinoma is rare.

This patient presented with a 15x12x11-cm mass in her right axilla. It was nontender and firm in consistency. It was free of underlying structures. She reported no other symptoms. She smoked and had a family history of breast cancer. She was evaluated for axillary lymphadenopathy, but no axillary lymphadenopathy was present. The mass was diagnosed using fine-needle aspiration cytology (FNAC) and revealed paucicellular adipocytes. This case is a case report, not official Navy Medical Department or Navy Service policy.

Firm

The most common location of accessory axillary breast tissue is the axilla, along the mammary ridge and milk line. The milk line is a thick band of tissue that runs from the armpit to the groin. However, it can also be found on the face, back of the neck, shoulder, hip, thigh, and mid-back.

Axillary accessory breasts are often missed during screening mammography. However, oblique views or an exaggerated cranio-caudal view can help identify these lesions. In addition, ultrasonography (USG) may help rule out other breast conditions. Because accessory axillary breast tissue typically shows low signal on USG, it may be missed by conventional mammograms.

Is not contiguous with ipsilateral breast tissue

In some women, accessory breast tissue may mimic glandular tissue on mammogram, ultrasound, or MRI, but it should not be contiguous with the ipsilateral breast tissue. This type of breast tissue, also known as the axillary tail of Spence, may be asymptomatic and not require treatment. If it is symptomatic, however, a surgeon should exercise caution. This tissue may be a source of lymphoedema, and surgical removal should be done only by a surgeon with extensive knowledge of lymphatic drainage.

Occurs in 2-6% of women

A condition known as accessory breast tissue is a developmental variation of the breast that is typically not diagnosed until puberty. It affects about two to six percent of women, and one to three percent of men. It most commonly manifests itself as solitary accessory nipples that develop along the mammary line, extending downward to the groin and inner thigh. Although it is not life-threatening, it may be painful and may require surgical resection.

It can make the armpit area appear bulky and meaty. It can also cause irritation and may make clothes fit poorly. Some women may even experience discomfort and pain when wearing certain types of clothing, like bras. Treatments include liposuction and excision.

Causes

The causes of accessory axillary breast tissue can be varied and are difficult to pinpoint. In one case, a 28-year-old Ethiopian woman presented with a mass in the left axilla. She had no history of fever, cough, or weight loss. On physical examination, the mass measured 5 cm by 4 cm and was separated from the left breast. It was diagnosed as a fibroadenoma of axillary accessory breast tissue and histopathology confirmed the diagnosis. The patient was informed of the cause of the condition and the treatment options available.

A FNAC scan can help distinguish between benign and malignant swellings in an axilla. A core needle biopsy can also establish the histological type of the tumor and its receptor status. A local ultrasound is also used to confirm the axillary location of the mass.

Treatment

The presence of accessory axillary breast tissue can be a source of concern for both men and women. Although these masses are usually benign, they can cause discomfort and increase in size. More women are seeking a consultation with a plastic surgeon due to their concerns. The first step to treatment is to rule out breast cancer. If cancer is not present, counseling can help women make an informed decision. In some cases, an axillary mass can be treated surgically, but the technique should be appropriate for the specific case.

Since accessory axillary breast tissue cancer is extremely rare, it is important to recognize it as soon as possible. Early diagnosis may prevent the need for an ipsilateral mastectomy and reduce the risk of secondary breast cancer. During the diagnostic process, an oncologist should look for lesions in accessory breast tissue and note any changes. If the tissue is deemed to be cancerous, it may be treated as a preventive excision, which is often a good option for high-risk women.

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