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Breast-feeding With Ectopic Axillary Breast Tissue

  • Anthony J. Viera
    Correspondence
    Address reprint requests and correspondence to LT Anthony J. Viera, MC, USNR, at his current address: USNH Guam, PSC 490 Box NCTAMS, FPO AP 96538–1600
    Affiliations
    Department of Family Practice, Naval Hospital Jacksonville, Jacksonville, Fla
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      Axillary breast tissue, which may be an extension of the tail of Spence, is a normal variant that has been reported in the literature relatively infrequently, although it may be present in a number of asymptomatic women. If axillary breast tissue becomes symptomatic, this usually occurs during pregnancy or immediately postpartum when a woman begins breast-feeding. Symptoms are swelling and pain due to engorgement. A literature review revealed that management is generally conservative, with cessation of breast-feeding to allow regression of the tissue. This report describes a woman who successfully pumped her axillary breasts to relieve pain and engorgement; this allowed her to continue breast-feeding for several weeks. Axillary breast tissue should be monitored for pathologic change.
      Polymastia, the presence of supernumerary breasts, is infrequently seen but may be present in up to 6% of women.
      • Lesavoy MA
      • Gomez-Garcia A
      • Nejdl R
      • Yospur G
      • Syiau TJ
      • Chang P
      Axillary breast tissue: clinical presentation and surgical treatment.
      Ectopic breast tissue may become apparent only during pregnancy or the puerperium because of its hormonally sensitive nature. Ectopic breast tissue can make breast feeding difficult. There is likely a genetic predisposition to this condition. It is a normal variant, but malignant change can occur.

      Report of a Case

      An 18-year-old female African American (gravida 1) who gave birth at 36 weeks' gestation complained of painful lumps under her arms on postpartum day 1 (Figure 1). The lumps had developed within a few hours after delivery. She had been breast-feeding without difficulty but noted that her breasts were beginning to become engorged.
      Figure thumbnail gr1
      Figure 1Axillary breast tissue. A, Frontal view. B, Lateral view.
      On physical examination, the patient's breasts were engorged, but there were no signs of mastitis. She was afebrile. The bilateral orange-sized swellings in the axillae were soft and tender. A circular area of more prominent pigmentation that resembled an areola was present on each side, but no nipple was apparent. When the swellings were compressed, a small amount of colostrum-like fluid was expressed from pores in the hyperpigmented areas.
      The patient reported that the axillae had never previously been swollen. Notably, the patient's mother had had a similar problem after her pregnancies. The patient was advised that the tissue was accessory breast tissue that had become engorged as a result of the pregnancy and that the engorgement would continue with breast-feeding. She was given the option of either discontinuing breast-feeding with breast binding or trying to continue breast-feeding with pumping of the axillary breasts to decrease the engorgement. She chose to continue breast-feeding and breast-fed successfully for 8 weeks. Pumping alleviated the pain and engorgement of the axillary breasts.

      Discussion

      Axillary breast tissue is reported as a common variant of supernumerary breast tissue.
      • Bland KI
      • Romrell LJ
      Congenital and acquired disturbances of breast development and growth.
      It may be present in 2% to 6% of women.
      • Lesavoy MA
      • Gomez-Garcia A
      • Nejdl R
      • Yospur G
      • Syiau TJ
      • Chang P
      Axillary breast tissue: clinical presentation and surgical treatment.
      Axillary breast tissue is commonly bilateral (as in our patient) and is often unassociated with a distinct areola or nipple.
      • Greer KE
      Accessory axillary breast tissue.
      The most rapid growth of such tissue occurs during pregnancy.
      • Greer KE
      Accessory axillary breast tissue.
      Patients may be misdiagnosed prenatally as having a lipoma, lymphadenopathy, or hidradenitis suppurativa.
      • Lesavoy MA
      • Gomez-Garcia A
      • Nejdl R
      • Yospur G
      • Syiau TJ
      • Chang P
      Axillary breast tissue: clinical presentation and surgical treatment.
      During pregnancy or the puerperium, the ectopic breast tissue tends to become symptomatic.
      • Greer KE
      Accessory axillary breast tissue.
      Lactation has been reported through skin pores overlying the axillary breast
      • Roux JP
      Lactation from axillary tail of breast.
      (as in our patient).
      Axillary breast tissue can develop with any disease that affects the normal breast, including breast cancer.
      • Lesavoy MA
      • Gomez-Garcia A
      • Nejdl R
      • Yospur G
      • Syiau TJ
      • Chang P
      Axillary breast tissue: clinical presentation and surgical treatment.
      • Yerra L
      • Karnad AB
      • Votaw ML
      Primary breast cancer in aberrant breast tissue in the axilla.
      However, aberrant breast tissue is no more likely to become malignant than normal breast tissue.
      • Berman MA
      • Davis GD
      Lactation from axillary breast tissue in the absence of a supernumerary nipple: a case report.
      Other conditions that have been reported to occur in ectopic breasts are mastitis, fibrocystic changes, fibroadenoma, and phyllodes tumor.
      • Velanovich V
      Ectopic breast tissue, supernumerary breasts, and supernumerary nipples.
      There is a possible familial inheritance of this embryologic variant. Our patient reported that her mother also had axillary breast tissue. A family with 6 affected women in 2 generations has been reported.
      • Weinberg SK
      • Molulsky AG
      Aberrant axillary breast tissue: a report of a family with six affected women in two generations.
      One theory is that an autosomal dominant gene of variable expressivity is inherited that inhibits normal regression of the embryonic mammary ridge.
      • Weinberg SK
      • Molulsky AG
      Aberrant axillary breast tissue: a report of a family with six affected women in two generations.
      Management of ectopic breast tissue is usually conservative. The enlargement and associated symptoms are reportedly worse with subsequent pregnancies.
      • Greer KE
      Accessory axillary breast tissue.
      With symptomatic enlargement of the breast tissue during the puerperium, cessation of breast-feeding leads to regression of the tissue.
      • Lesavoy MA
      • Gomez-Garcia A
      • Nejdl R
      • Yospur G
      • Syiau TJ
      • Chang P
      Axillary breast tissue: clinical presentation and surgical treatment.
      • Bland KI
      • Romrell LJ
      Congenital and acquired disturbances of breast development and growth.
      • Greer KE
      Accessory axillary breast tissue.
      Our patient elected to continue breast feeding while pumping the axillary breasts, an approach not mentioned in previous case reports. She did so successfully for 8 weeks, at which time she elected to discontinue breast-feeding.
      Women with asymptomatic axillary breast tissue should undergo the same screening as those with normally located breast tissue, including mammography if possible.
      • Berman MA
      • Davis GD
      Lactation from axillary breast tissue in the absence of a supernumerary nipple: a case report.
      If signs of malignancy develop, such as a firm or discrete mass or skin changes with retraction, evaluation should include problem-solving mammography or ultrasonography followed by biopsy if necessary.
      • Berman MA
      • Davis GD
      Lactation from axillary breast tissue in the absence of a supernumerary nipple: a case report.
      For diagnostic or cosmetic reasons, elliptical incisions in the axillae facilitate dissection and removal of the axillary breast tissue.
      • Lesavoy MA
      • Gomez-Garcia A
      • Nejdl R
      • Yospur G
      • Syiau TJ
      • Chang P
      Axillary breast tissue: clinical presentation and surgical treatment.
      An association between supernumerary breast tissue and renal anomalies has been observed.
      • Berman MA
      • Davis GD
      Lactation from axillary breast tissue in the absence of a supernumerary nipple: a case report.
      • Mehes K
      Association of supernumerary nipples with other anomalies.
      Investigation of the genitourinary tract can be limited to patients with symptoms.
      • Berman MA
      • Davis GD
      Lactation from axillary breast tissue in the absence of a supernumerary nipple: a case report.

      Conclusion

      Although not a frequent finding, axillary breast tissue may become evident during a woman's immediate postnatal course as she begins breast-feeding. As a normal variant, the presence of such tissue does not itself preclude breast-feeding; however, if a woman is too uncomfortable, breast feeding can be discontinued, and the breast tissue will regress. If a woman chooses to continue breast-feeding, pumping of the axillary tissue, even in the absence of a supernumerary nipple, may be possible and should alleviate engorgement and pain. Patients should be informed that enlargement of the ectopic breast tissue is likely to recur and, perhaps, be worse with each subsequent pregnancy. Surgical excision can be offered for cosmetic reasons. Otherwise, the axillary breast tissue should be monitored for pathologic changes.

      References

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        • Chang P
        Axillary breast tissue: clinical presentation and surgical treatment.
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        Congenital and acquired disturbances of breast development and growth.
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