La reconstruction mammaire par implant est la technique la plus courante après mastectomie. Elle restaure immédiatement le volume du sein, en un ou deux temps opératoires selon la qualité de la peau.
Dr Zeitoun, breast surgeon, examines the area, confirms on ultrasound that this really is breast tissue and not something else, and tells you plainly whether excision is warranted in your case. Consultations in the 8th arrondissement of Paris, surgery as a day case at Clinique Hartmann (Neuilly).
Around the sixth week of embryonic life, two thickened strips of tissue form on either side of the body, running from the armpit down to the groin. It is along these two paths that breast tissue may develop.
During fetal development these strips almost entirely disappear. Just one point remains on each side, at the level of the fourth rib: the two breasts.
Almost entirely. In a proportion of the population that regression remains incomplete and a fragment of tissue survives. It produces a small amount of glandular breast tissue outside the breast itself. By far the commonest site is the armpit, though it also occurs below the breast, on the chest wall and, more rarely, in the groin.
This is what most patients discover in the consulting room, and it changes everything: this tissue is genuine breast tissue. It does not merely resemble breast tissue: it is breast tissue, with the same lobules, the same ducts and the same architecture.
It consequently follows the same hormonal variations as your breasts. It swells before a period, enlarges during pregnancy, and can fill with milk while you are breastfeeding, sometimes leaking where a small duct opens onto the skin. It evolves with you over the years and changes at the menopause.
It is common. Depending on the study and the criteria used, somewhere between 1 and 6% of the population is thought to carry such a remnant. Many women live with it without ever knowing, having always assumed their armpits were simply "a bit thick". Others discover it abruptly during a first pregnancy, when the area starts to swell.
One point deserves stating plainly: the condition is benign, it results from no error on anyone's part, and it signals no underlying disease. Where it becomes troublesome, excision settles the matter for good.
The diagnosis is usually made on clinical examination, in a matter of minutes — provided the patient is examined standing, with her arms raised. Lying down, the tissue flattens out and becomes far less obvious.
In 1915 a Finnish anatomist named Kajava described every possible form of supernumerary breast tissue. His description is still in use, and it explains why no two patients present in quite the same way.
The one that matters in clinic is form IV. Gland with no nipple and no areola, invisible on the surface: nothing signals that this is breast tissue. It is the one mistaken for a lymph node, for a lipoma, for a roll of fat. And it is by far the commonest.
Before concluding, a handful of other diagnoses that present in the same place are routinely ruled out. That is the purpose of the consultation and the ultrasound.
That last distinction causes the most difficulty. Imaging is what settles it: ultrasound distinguishes unambiguously between accessory tissue, which appears as a discrete structure separate from the breast, and a simple axillary extension continuous with the normal breast.
A clinical examination and an ultrasound are enough to make the diagnosis — and to decide, in the same appointment, whether it should be removed.
This is where the substance of this article lies, and it is what separates accessory breast tissue from a simple matter of body shape.
So it can develop everything a breast develops: fibroadenoma, cyst, mastitis, an abscess while breastfeeding — and, far more rarely, breast cancer. It is uncommon, but it is well documented in the literature.
Screening views cover the breast and part of the axillary tail. Accessory tissue sitting high up can fall outside the field — year after year, without anyone noticing.
In an area you do not examine yourself, were never taught to check, and that routine imaging does not cover, a lesion can grow for a long time before it is spotted. That argument carries weight.
There is no cause for alarm. Cancer arising in ectopic breast tissue remains rare: it accounts for a very small minority of breast cancers. Having accessory tissue does not raise your personal risk of breast cancer — you simply have slightly more breast tissue, and it happens to sit somewhere that is watched less closely.
But it should not be ignored either. In practice that means three things. The area must be known about and flagged to your radiologist, so that it is examined by ultrasound at your check-ups. Any mass that is hard, fixed, newly appeared or no longer follows the cycle must be biopsied exactly as a breast lesion would be. And when excision is decided upon, the tissue removed always goes for pathological analysis — never straight into the bin.
This is, incidentally, one of the strongest arguments in favour of excision when it is otherwise justified: it permanently removes an area of breast tissue that standard screening monitors poorly.
The work-up amounts to very little. A clinical examination standing with the arms raised, and an ultrasound of the armpit and both breasts. A mammogram is added according to your age, and an MRI only in complex situations or where there is a family history. No invasive test is needed to make the diagnosis.
There is no obligation to operate on accessory breast tissue. Tissue that is discreet, painless and has never caused you trouble can stay where it is and simply be monitored. The question changes as soon as it starts making itself felt.
This needs saying plainly, because many patients arrive apologising for it: discomfort and the effect on daily life are legitimate indications for surgery, every bit as much as a lump. Never raising your arms at the beach, choosing your clothes around your armpit, avoiding certain postures for ten years — none of that is vanity.
Nor are these symptoms that improve with time. The tissue remains hormone-responsive throughout your reproductive life. Every pregnancy will make it grow again. No cream, no diet and no amount of exercise makes glandular tissue disappear — a classic source of frustration in very active patients, who lose the surrounding fat and find the tissue standing out more than before.
This is the point on which I see the most patients disappointed by surgery performed elsewhere, and it deserves explaining.
This is precisely why the choice of technique is made after the ultrasound, once the proportion of gland to fat is known — never from simply looking at the area. This is gone through with you at the preoperative consultation, before any decision is taken.
Removing accessory breast tissue is a short procedure, performed as a day case at Clinique Hartmann in Neuilly-sur-Seine: you come in during the morning and leave by the end of the day.
This is a step on which I do not compromise. The day before or on the morning of surgery, standing, with your arms raised and then tensed, the limits of the tissue are drawn on the skin with a marker pen. Once you are lying down and asleep, the tissue spreads out and its edges become indistinct: marking beforehand is what guarantees that all of it is removed, not merely its centre.
It is also the moment when we agree together on exactly where the scar will sit, placing it in the crease that forms naturally when you lower your arm.
Anaesthesia is usually general, with a compulsory anaesthetic consultation at least 48 hours beforehand. Deep local anaesthesia is an option for small, one-sided tissue.
The incision follows the axillary crease. The tissue is dissected down to the deep plane and removed in one piece, which allows reliable analysis. Two structures are carefully respected: the vessels and lymph nodes of the armpit, which are left alone, and the intercostobrachial nerve, which supplies sensation to the inner arm and is identified so that it can be preserved.
Where there is a substantial fatty component, additional liposuction blends the contours during the same procedure. Closure is with absorbable sutures and a compressive dressing. A drain is used only exceptionally, for very large bilateral cases.
The tissue removed always goes for pathological analysis, even when everything looked entirely unremarkable.
Recovery is straightforward, but these situations are better known about beforehand than afterwards.
Getting the timing right. We do not operate while you are breastfeeding: the tissue is then congested and actively secreting, which raises the risk of seroma and of wound-healing problems. We wait until you have weaned, and then a few months more. Operating before a pregnancy, on the other hand, is often the best choice, since pregnancy and breastfeeding are when accessory tissue causes the most trouble.
Pain with every cycle, discomfort with clothing, skin irritation, or simply wanting to be done with it: excision is a short day-case procedure, with a scar hidden in the crease of the armpit. One consultation is enough to confirm the indication and set a date.
The armpit is a particular place: it moves with every movement of the arm, it perspires, it rubs. The instructions for the first few weeks follow directly from that.
The armpit regains a smooth contour, with no fullness when you raise your arm. The cyclical swelling disappears, and with it the premenstrual pain in the area. The scar, set in the crease, is red for a few weeks and then fades steadily over twelve to eighteen months; once mature it is hard to find, even with your arm raised.
The pathology result comes back within ten to fifteen days and is given to you in person at a consultation. In the great majority of cases it simply confirms normal breast tissue. If it shows something else — a fibroadenoma, a lesion needing follow-up, exceptionally more than that — it is managed exactly as a breast lesion would be, and the case is discussed at the multidisciplinary meeting.
Tissue that has been removed does not grow back. Recurrences almost always correspond to tissue left behind, which is exactly what the preoperative marking and the en-bloc excision are designed to prevent.
One thing worth knowing is that this embryonic path runs down both sides: if only one side has been operated on, the other may declare itself later, typically during a pregnancy. That is one of the reasons a bilateral procedure in a single sitting is readily discussed when both sides are involved.
Otherwise you go back to the routine surveillance appropriate to your age, adjusted if you have dense breasts or a family history.
The questions that come up most often in clinic. If yours is not here, ask it at your consultation — or ask Sophie, the site's assistant, at the bottom right.
In the great majority of cases, accessory breast tissue: genuine breast tissue left in the armpit during fetal life. Because it is real breast tissue, it responds to hormones exactly as your breasts do — swelling and becoming tender before your period, then settling. A lymph node never follows the cycle. That cyclical pattern is the most telling sign, and it points to the diagnosis from the clinical examination onwards — see also what to do when you find a lump.
No. It is a benign congenital variation, present since birth even though it only appears at puberty. The point to understand is a different one: because it is genuine breast tissue, it can develop the same lesions a breast can — cyst, fibroadenoma, mastitis, and far more rarely a cancer. And this area is poorly covered by screening. That is a reason to have it examined, not a reason to worry.
No. Tissue that is small, painless and does not bother you can simply be monitored. Excision is discussed when it swells and hurts with every cycle, when it shows under clothing or interferes with sport, when it irritates the skin, when it caused problems during breastfeeding, when it contains a lump — or when you no longer accept how it looks. That last reason is perfectly valid on its own.
Poorly, and this matters. Standard views take in the breast and part of the axillary tail, but not the whole armpit. Accessory tissue sitting high up can therefore fall outside the field, year after year. Ultrasound, by contrast, examines it perfectly well, just as for dense breasts. Point the area out to your radiologist so that it is scanned specifically.
Liposuction removes fat, not gland, which is firm fibrous tissue. If the swelling is mostly fatty, liposuction alone may be enough and leaves a tiny scar. But if it is mostly glandular, which is the commoner situation, liposuction on its own leaves the tissue in place: the cyclical swelling persists and the lump comes back. It is the leading reason for revision surgery. The two techniques are often combined in the same procedure. Where there is doubt, a second opinion settles it before you commit.
It is placed in a natural crease of the armpit, where the skin already folds when you lower your arm. It measures 4 to 6 cm. Red for a few weeks, it fades over twelve to eighteen months and becomes very hard to find — the same principles apply as after any benign breast procedure. Because the armpit is an area of friction, keeping it out of the sun, avoiding shaving in the early weeks and massaging the scar genuinely change the outcome.
It is a day case: you come in during the morning and leave by the end of the day. Anaesthesia is usually general, sometimes deep local. The tissue is marked while you stand, removed in one piece through the axillary incision, and then analysed. Allow 30 to 40 minutes depending on the volume and on whether one or both sides are treated, at Clinique Hartmann. A compressive dressing stays on for a few days.
The commonest is a seroma, a collection of clear fluid under the scar, which is aspirated in clinic if necessary. Less often: a haematoma, an infection, temporary numbness of the inner arm from the intercostobrachial nerve, or a thick scar. All of these are monitored and treatable.
If the tissue has been removed in full, no: what is taken out does not grow back. Recurrences almost always correspond to tissue left behind, particularly after liposuction alone or an incomplete excision. That is the whole point of marking you standing up beforehand and removing the tissue in one piece, with the result confirmed by analysis of the specimen. If only one side was operated on, however, the other may declare itself later.
Not while breastfeeding: the tissue is congested and secreting, and the risk of wound-healing problems is higher. We wait until you have weaned, then a few months more. Before a pregnancy, though, is often the right moment — pregnancy and breastfeeding are when this tissue causes the most trouble. The procedure does not touch the breasts and does not prevent future breastfeeding; raise it at your preoperative consultation.
The same embryological origin, on the same path, but not the same situation. An extra nipple — polythelia — is often taken for a mole and usually sits below the breast. There is not always gland underneath it. Removing it is very straightforward, under local anaesthetic, leaving a scar of a few millimetres — as with other benign breast conditions.
The procedure corresponds to a listed item in the French health system schedule, QEFA006 — excision of ectopic breast tissue or aberrant mammary gland. Where the tissue is symptomatic — cyclical pain, functional discomfort, skin irritation, a lump requiring analysis, previous mastitis — the procedure is covered on that basis.
Dr Zeitoun practises in sector 2, which means additional fees above the standard tariff apply. The amount is set out at your consultation and a detailed written quotation is handed to you in person before any decision, so that you can submit it to your insurer.
To go further on benign breast conditions and how they are managed.
Fibroadenoma, cyst, papilloma, atypical hyperplasia, phyllodes tumour: the reference page on benign lesions and their treatment.
SymptomWhat to do, in what order and within what timeframe when you feel a mass — in the breast or under the arm.
DecisionA benign lesion whose removal is nonetheless discussed: how the decision is built after a biopsy.
SymptomWhen to worry and when not to — and why an intraductal papilloma is the leading cause.
ImagingCore biopsy, vacuum-assisted biopsy, BI-RADS: how a lesion is sampled and how the result is read.
The nippleNipple "eczema" that will not heal despite creams: the signs that should raise the alarm.
ScreeningWhat breast density changes about your screening, and which additional tests are worthwhile.
Breast cancerChemotherapy before surgery: what it changes for breast conservation, the armpit and reconstruction.
A lump under your arm that swells before your period, a fullness that bothers you in your clothes, an area that complicates pregnancy or breastfeeding? Dr Jérémie Zeitoun, breast surgeon trained at Gustave Roussy and Institut Curie, examines the area, confirms the diagnosis on ultrasound and tells you whether excision is warranted. Bring any recent imaging you have. Consultations at the practice in the 8th arrondissement of Paris, day-case surgery at Clinique Hartmann in Neuilly-sur-Seine.