Axillary breast: Navigating uncharted terrain

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Author: Medha Bhave
Date: September-December 2015
From: Indian Journal of Plastic Surgery(Vol. 48, Issue 3)
Publisher: Medknow Publications and Media Pvt. Ltd.
Document Type: Report
Length: 1,937 words
Lexile Measure: 1270L

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Byline: Medha. Bhave

Introduction: Axillary breast is a common condition that leads to discomfort and cosmetic problems. Liposuction alone and open excision are two techniques used for treatment. Materials and Methods: This study assesses the results of treatment in 24 consecutive patients, operated between 2005 and 2015.All patients had Kajava class IV masses. Three were treated by liposuction alone, while 21 were treated by open axillaplasty with limited liposuction. Results: One patient treated by liposuction alone had to be re-operated for a residual lump, while with axillaplasty, no major complications were observed and the results were uniformly good. Discussion: Certain points of technique emerged as major determinants in obtaining the best results. In brief, these are: a) limited skin excision; b) placing elliptical incisions within the most lax, apical axillary skin, irrespective of the location of the lump; c) raising skin flaps at the level of superficial fascia; d)meticulous dissection and preservation of the nerves, especially the second intercostobrachial; f) judicious liposuction for eliminating dog ears and axillary sculpting only; g) avoiding drains. Conclusion: Open axillaplasty with limited liposuction is the best way to minimise complications and produce good results.

INTRODUCTION

Accessory breast tissue may present as a mass at any place along the embryologic 'mammary streak', including the axillae, chest wall or vulva. The face, neck, ear, lateral thigh, buttock or the knee may rarely be the sites of aberrant or ectopic tissue. [sup][1],[2] As many as 2-6% of women and 1-3% of men have this congenital condition, and 20% of these are found in the axilla. [sup][3]

Despite the relatively frequent occurrence, this condition has received sparse attention in plastic surgery journals.

In 1915, Kajava published a classification that is still used. [sup][3],[4]

*Complete glandular breast tissue with areola and nipple *Nipple and glandular tissue, no areola *Areola and glandular tissue without a nipple *Glandular tissue only *Nipple and areola but no gland (pseudomamma) *Nipple only (polythelia) *Areola only (polythelia areolaris) *Patch of hair only (polythelia pilosa)

Clinically, lipoma, lymphadenopathy, hidradenitis, sebaceous cyst, vascular malformation or malignancy may be suspected before axillary breast is diagnosed. Mammogram, ultrasound, magnetic resonance imaging (MRI), needle biopsy or surgical biopsy can be used as diagnostic tools. [sup][3]

Proper choice of treatment technique is critical in order to obtain good results. [sup][4] Liposuction and surgical excision are the two main modalities, both with their own advantages, limitations and complications.

This study retrospectively examines the surgical technique, and results thereof, in 24 consecutive patients presenting with axillary breast lumps and presents the inferences drawn regarding the best surgical approach.

MATERIALS AND METHODS

We present 24 patients treated surgically for axillary breast from 2005 to 2015 and the refinement of technique that we developed during the course of the study. The age group was 18-62 years but the majority of patients were 22-42 years old. All patients had bilateral lumps except 1 [Table 1].{Table 1}

All patients had Kajava...

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Gale Document Number: GALE|A439726518