Indian Journal of Dermatology
CORRESPONDENCE COLUMN
Year
: 2007  |  Volume : 52  |  Issue : 2  |  Page : 118--120

Polymastia of axillae


Surajit Nayak, Basanti Acharjya, Basanti Devi 
 Dept. of Skin and VD, MKCG Medical College, Berhampur, Orissa, India

Correspondence Address:
Surajit Nayak
Dept. of Skin and VD, MKCG Medical College, Berhampur, Orissa
India




How to cite this article:
Nayak S, Acharjya B, Devi B. Polymastia of axillae.Indian J Dermatol 2007;52:118-120


How to cite this URL:
Nayak S, Acharjya B, Devi B. Polymastia of axillae. Indian J Dermatol [serial online] 2007 [cited 2020 Nov 1 ];52:118-120
Available from: https://www.e-ijd.org/text.asp?2007/52/2/118/33297


Full Text

We present a case of 30-year-old, primigravida, presenting with lipomatous swelling in both axillae. As history goes, patient first noticed the swellings during pregnancy as two small, nontender growths, in both axilla symmetrically, but subsequently it grew rapidly following delivery to attain the present size. Examination revealed [Figure 1],[Figure 2] solitary, bilateral symmetrical lobular, soft, tender swelling, mobile freely under overlying normal skin. A clinical diagnosis of Polymastia (accessory breast tissue) without nipple was made. Routine hematological and biochemical parameters were in normal limits. Ultrasound of abdomen and pelvis was normal. FNAC and HP study were consistent with clinical diagnosis. The diagnosis was not considered during antenatal examinations probably because of absence of the nipple and the areola. However, the patient never gave any history of development of swelling during puberty. Subsequently, these swellings increased in size during pregnancy and lactation through hormonal influence, which strongly reinforces the diagnosis.

Sir, as we know, during the fourth week of gestation, paired ectodermal thickenings termed mammary ridges or milk lines develop on the ventral surface of the embryo and extend in a curvilinear fashion convex towards the midline from the axillae to the medial thigh. In normal human development, these ridges disappear except at the level of the fourth intercostal space on the anterior thorax, where the mammary gland subsequently develops. But sometimes this involution of the milk line is incomplete, resulting in the formation of accessory mammary tissue from the redundant clusters of ectopic primordial breast cells. Between 1% and 5% of men and women have supernumerary or accessory nipples or, less frequently, supernumerary or accessory breasts. [1],[2]

Approximately one third of affected individuals have more than one site of supernumerary breast tissue development. Most of this accessory breast tissue has no physiologic significance, but some may enlarge with the onset of puberty, pregnancy or lactation and can be the site of breast carcinoma.

Approximately 67% of accessory breast tissue occurs in the thoracic or abdominal portions of the milk line, often just below the inframammary crease and more often on the left side of the body, another 20% occurs in axilla. [3] Males and females have an overall equal incidence, but differences are observed within ethnic groups. Most cases are sporadic, but approximately 6% are familial and are believed to represent an autonomic dominant trait with variable penetrance and many cases has been reported by various authors. [4]

Sir, as accessory breast behave as normal breast tissue, may subject to same diseases as a normal breast, need to be followed up for diseases, as in a normal breast. But the most important fact is, congenital breast malformations can be extremely psychologically debilitating to the individual. So, accurate diagnosis, counseling and treatment are necessary to alleviate the sense of deformity and unattractiveness that is often present. Proper timing of surgical intervention is necessary to optimize functional, psychological and aesthetic outcomes. Excision is usually recommended prior to puberty or at any age when the condition is recognized. Polythelia or supernumerary nipple is the most common form of accessory breast tissue malformation has been reported to be associated with nephrourological anomalies, but no reports has been indicated in regards to its association to polymastia. [4],[5],[6],[7],[8],[9] But, as polythelia and polymastia may co-exist, all cases of polymastia should be subjected to thorough physical examination, urine analysis and renal ultrasound to exclude any renal pathology.

References

1Dixon JM, Mansel RE. ABC of breast diseases: Congenital problems and aberrations of normal breast development and involution. BMJ 1994;309:797-80.
2Gray SW, Skandalakis JE. Embryology for surgeons: Embryological basis for the treatment of congenital defects. WB Saunders Company: Philadelphia, London and Toronto; 1972.
3Revis DR Jr, Caffee HH. Breast embryology. eMedicine. [Last updated on 2006 Mar 10].
4Galli-Tsinopoulou A, Krohn C, Schmidt H. Familial polythelia over three generations with polymastia in the youngest girl. Eur J Pediatr 2001;160:375-7
5Casey HD, Chasan PE, Chick LR. Familial polythelia without associated abnormalities. Ann Plast Surg 1996;36:101-4.
6Leung AK, Robson WL. Renal anomalies in familial polythelia. Am J Dis Child 1990;144:619-20.
7Meggyessy V, Mehes K. Association of supernumerary nipples with renal anomalies. J Pediatr 1987;111:412-3.
8Mehes K. Association of supernumerary nipples with other anomalies. J Pediatr 1979;95:274-5.
9Goedert JJ, McKeen EA, Fraumeni JF Jr. Polymastia and renal adenocarcinoma. Ann Intern Med 1981;95:182-4.