Accessory Breast Tissue Removal

What is Accessory Breast Tissue?

Accessory breast tissue refers to additional breast tissue that forms outside of the normal breast area. This tissue is a result of a developmental condition known as polymastia (or sometimes referred to as supernumerary breast tissue). During fetal development, the milk lines (also called mammary ridges) form along each side of the body, and occasionally, accessory breast tissue develops along these lines.

This extra tissue can appear anywhere along the milk lines, from the armpits to the groin, but it is frequently found in the underarm area. It can vary in size and may have all the characteristics of normal breast tissue, such as the ability to enlarge during hormonal changes like puberty, menstruation, or pregnancy.

In many cases, accessory breast tissue may go unnoticed unless it becomes tender or enlarged, especially during hormonal fluctuations. It’s typically harmless, but in rare cases, it can cause discomfort, or in very rare instances, develop into conditions like breast cancer.

Most surgeons tend to remove accessory breast tissue through a large scar in the axilla. However, the axilla is not an ideal place to hide a scar as it often becomes thick and pulls on the breast when the arm is elevated. To optimise the cosmetic result, I have modified some of these techniques by minimising the scars and hiding them within the areolar (the pigmented area).

The options for surgical management of accessory breast tissue are:

A: Liposuction – This is a useful technique in patients who have minimal loose skin and fatty accessory tissue with a minimal glandular component. The liposuction reduces the fat and encourages skin to retract. However, liposuction cannot remove glandular breast tissue, which is firm and fibrous. Patients with a significant amount of glandular breast tissue may be left with a prominent lump or laxity of the skin.

B: Glandular avulsion and liposuction - This will address both the fat deposition and breast tissue and encourage skin to tighten. The technique is performed through 2 small stab incisions in the axilla and leaves minimal scars. It is the most common technique and addresses all elements of accessory breast tissue.

C: Skin excision in combination with liposuction and glandular avulsion – Avoiding scars wherever possible is preferable, however, if there is residual laxity that is unlikely to retract it can be removed with a much smaller scar and less risks and complications.

Liposuction is used to remove fatty tissue through several stab incisions, hidden within the areolae. These scars are almost unnoticeable. The surgery takes about 1 hour to complete under general anaesthetic, as a day case procedure.

Having cosmetic surgery should be a very positive experience. Complications are infrequent and usually minor. However, all surgery has risk, and it is important that you are aware of possible complications. All the risks will be discussed in detail at your consultation. However, if you have further questions or concerns, please do not hesitate to discuss them with me. Decisions about cosmetic surgery should never be rushed.

These risks can be divided into those specific to the surgery and those that relate to the anaesthesia.

General Anaesthetic risks: An anaesthetic is very safe, however, should a complication arise, the relevant medical expertise is immediately available to deal with this.

The risks increase if you have certain medical problems, which will be discussed at length during the consultation. The risks include:

  • Unintended intraoperative awareness, which is very rare.
  • Dizziness and nausea.
  • Sore throat.
  • Damage to teeth or mouth.
  • Nerve injury due to body positioning.
  • Allergic reaction or anaphylaxis.
  • Malignant hyperthermia, which is a rare life-threatening condition.

The anaesthetist will go through these risks in more detail prior to your surgery.

Scars: The surgery is normally performed through a 5mm stab incision hidden in a skin crease in the axilla, and normally settle remarkably well, so that the scars are barely perceptible. However, some patients heal with noticeable thickened, thin or stretched scars.

Bruising and swelling: This is normal and may take approximately 3 weeks to settle.

Haematoma: This is clotted blood that collects in the breast. A haematoma often occurs within 4 to 6 hours post-surgery. Any increase in swelling or pain should be reported immediately for assessment. Should the haematoma be significant, it will have to be washed out in theatre and any bleeding vessel(s) identified and cauterised. This does not normally delay your recovery or change the cosmetic result.

Infection: The risk of infection is inherent with any surgical procedure, albeit very uncommon in elective breast procedures. Antibiotics are administered during surgery and for 7 days after surgery to minimise the risks. Less than 1% of patients develop an infection post-operatively and rarely require any intervention, apart from further antibiotic treatment.

Numbness, reduced sensation or oversensitivity: A reduction in nipple sensation may occur temporarily but normally resolves in the fullness of time.

Asymmetry: Remembering “they are sisters and not twins”, each breast is slightly different and will continue to be following surgery. However, if you have noticeable asymmetry before your surgery then this will be corrected as part of the surgery and will be discussed with you.

Loose skin: It is possible that the skin does not retract completely, and you may be left with some loose skin. If this is something of concern, then the skin would need to be removed at a second stage.

Wound healing problems: These are rare but can happen around the nipple or where the skin has been excised in select patients. These healing difficulties can range from minor problems, such as small scabs or areas of wound separation, to major issues, such as skin or nipple loss. Although very rare, this situation may require a skin graft to close the wound, meaning more surgery. Patients who have diabetes, smoke, are obese or elderly are at an increased risk of delayed healing.

Fat necrosis: Sometimes areas of fat within the breast scar form hard lumps called fat necrosis. Usually, no specific treatment is required, and the problem settles down over a 12-month period.

Recurrence: It is possible for accessory breast tissue to recur. This is very uncommon, unless there is a specific factor that continues to cause glandular tissue to grow, for example certain medications or hormones. All the risks will be discussed in detail at your consultation. However, if you have further questions or concerns, do not hesitate to discuss these with me. Decisions about cosmetic surgery must never be rushed and requires personal research.

Deep Vein Thrombosis/Pulmonary Embolism (DVT/PE): Following any surgical procedure it is possible to develop a blood clot in your legs, which could potentially break off and travel to your lungs. If the blood clot is large enough, it could prove fatal.

The overall risk for cosmetic surgery is less than 1%, but in order to reduce any risks of a DVT/PE, you will be provided with special stockings to wear in bed together with a blood thinning injection, if you are not mobile or have previously had a DVT or PE.

All the risks will be discussed in detail at your consultation. However, if you have further questions or concerns, do not hesitate to discuss these with me. Decisions about cosmetic surgery must never be rushed and requires personal research.

Any incisions will be closed with dissolvable sutures that do not need to be removed. I use a waterproof plaster to cover the incisions. You can shower as soon as you like after surgery, and the dressing will be removed in the clinic after a week.

Before you leave the hospital, you will be given a follow up appointment to see the nurses at one week to check your incisions and an appointment to see me a week after that. I will see you before then if necessary.

You will not be able to drive yourself home from hospital and, ideally, you should have someone to stay with you for a few days to assist you. If you have any concerns during this period, do contact the clinic for further advice.

Scar advice
Once the dressings are removed, I recommend that you massage the incisions, using small circular motions at least twice a day for 5 minutes. You can use any moisturising cream of your choice and apply firm pressure until it blanches.

The scars will also benefit from silicone scar gel (ScarAway® or Kelo-Cote®) twice a day, which will soften and fade them, as well as applying sunblock for 12 months to provide sun protection.

ScarAway® can be purchased from Healthcare Pharmacy at Governors Square in Grand Cayman.

When you get home, you should take things easy for the first week or so. Most people take a week off from work and gradually increase activity over the next few weeks. You can return to exercise at the gym after 3 weeks.

The fees for this surgery will not normally covered by your health insurance. However, if they are then most insured patients have a co-pay of 20% and certain policies only cover one side and half of the other breast. This means you are likely to have to pay towards the cost of your surgery. Any fees will be calculated, and you will be informed of the potential fees at your consultation.

For the majority who are self-funding patients, surgical fees are a combination of the hospital costs, surgeon fee, anaesthetic fees and any consumables. I do not charge additional fees for post-op appointments. The fees are based on the planned surgical time taken to perform the surgery, rather than procedure itself. This means that the costs are calculated fairly.

You will be given a quotation for surgery approximately 48 hours following your initial consultation with me.