Axillary breast tissue, which includes fat, nipple, areolae, and glandular tissue, can affect both women and men, with a prevalence of 2%–6% and 1%–3%, respectively. While it can be asymptomatic, many individuals experience functional and cosmetic concerns related to axillary breast tissue. Fortunately, there are several treatment options available for its removal. These options can be broadly categorized into nonsurgical methods, such as CoolSculpting and Kybella, and surgical methods, including liposuction, BodyTite liposuction, and excision. However, determining the most suitable technique for each case is crucial in achieving optimal outcomes. This article aims to provide a comprehensive guide to the treatment options for axillary breast tissue removal based on tissue type, skin laxity, and the presence of accessory nipples.
A patient with severe skin laxity, fat, and glandular tissue underwent bilateral liposuction with excision of the excess axillary breast tissue (A). The postoperative image (B) demonstrates the hidden scar placed high in the axillary crease.
Source
Treatment Options for the Clinical Management of Axillary Breast Tissue
Plastic and Reconstructive Surgery – Global Open11(8):e5189, August 2023.
Non-surgical Treatment Options: Can be Effective
CoolSculpting
CoolSculpting is a noninvasive technique that uses controlled cooling to eliminate fat cells. It involves the application of a CoolMini handpiece to each axilla, which cools the targeted area to a temperature of -11°C. This cold temperature freezes and destroys the fat cells, which are then naturally eliminated by the body over time. CoolSculpting can be effective for axillary breast tissue that consists mainly of fat and has minimal skin laxity. A CoolSculpting treatment can give a modest improvement.  Multiple treatment sessions may be required to achieve the desired results. It is important to note that CoolSculpting is not FDA-approved specifically for axillary breast tissue removal but may be used off-label based on the patient’s presentation and expectations.
Kybella
Kybella is an injectable treatment that utilizes deoxycholic acid to dissolve fat cells. While it is primarily used for submental fat reduction (double chin), it can also be considered as a nonsurgical option for axillary breast tissue removal. Kybella is injected directly into the targeted area, destroying fat cells. A single Kybella can be modestly effective for a small area. Similar to CoolSculpting, multiple treatment sessions may be necessary for optimal results. It is important to note that Kybella is not FDA-approved for axillary breast tissue removal.
Surgical Treatment Options: Most Effective
Liposuction: Less Invasive
Liposuction is a surgical procedure that removes excess fat deposits through a small incision. In the case of axillary breast removal, liposuction can be an effective technique for patients with moderate to severe skin laxity and excess fat. A liposuction cannula is inserted through a small incision in the axilla, and the excess fat is suctioned out. Liposuction alone is suitable for cases where the axillary breast tissue consists mainly of fat and does not require the excision of glandular tissue or accessory nipples.
BodyTite Liposuction: Less Invasive
BodyTite liposuction is a minimally invasive procedure that combines traditional liposuction with the application of radiofrequency energy. This energy-based technology tightens the skin and remodels adipose tissue during liposuction. BodyTite liposuction is particularly beneficial for patients with mild to moderate skin laxity and excess fat. The BodyTite device’s radiofrequency energy helps stimulate collagen production, leading to skin tightening. This technique can be performed simultaneously with liposuction to achieve enhanced results.
Liposuction with Excision: More Invasive
Liposuction alone may not be sufficient in cases with moderate to severe skin laxity and excess glandular tissue. Liposuction with excision is the preferred surgical technique for these patients. The procedure involves making a small incision in the axilla, through which a liposuction cannula is inserted to remove excess fat. After the liposuction is completed, the remaining glandular tissue is excised through a separate incision. This combined approach ensures the removal of fat and glandular tissue, resulting in a more comprehensive solution.
Excision: Most Invasive
For patients with axillary breast tissue that primarily consists of glandular tissue or accessory nipples, surgical excision is the recommended treatment option. This procedure involves making an incision in the axilla, removing the excess tissue, and closing the incision with sutures. Excision is particularly effective in cases where the axillary breast tissue is not amenable to liposuction alone. Although excision may result in visible scars, most patients are willing to accept this trade-off for a more substantial removal of the unwanted tissue.
Source: Treatment Options for the Clinical Management of Axillary Breast Tissue
Plastic and Reconstructive Surgery – Global Open11(8):e5189, August 2023.
Determining the Best Treatment Approach
The choice of treatment approach for axillary breast removal depends on several factors, including the type of tissue (fat or glandular), the extent of tissue excess, skin laxity, and the presence of accessory nipples. A treatment algorithm based on these factors has been developed to help surgeons make informed decisions. This algorithm provides a systematic approach to determining each patient’s most appropriate treatment option.
Treatment Algorithm for Axillary Breast Tissue Removal
- Grade 1: For patients with a small amount of axillary breast tissue consisting mainly of fat and minimal skin laxity, nonsurgical options such as CoolSculpting or Kybella. Multiple treatments of these types of procedures are usually required. Alternatively, liposuction is a good option for patients wanting a single and more effective treatment.
- Grade 2: Patients with more than a small amount of axillary breast tissue should consider liposuction with energy-based treatments such as BodyTite or Renuvion J Plasma.
- Grade 3: Liposuction with excision or liposuction with energy-based treatments such as BodyTite or Renuvion J Plasma is recommended for patients with moderate skin laxity, excess fat, and glandular tissue.
- Grade 4: Patients with severe skin laxity, large amounts of excess fat, and glandular tissue require excision as the primary treatment option, possibly combined with liposuction and the energy-based treatments mentioned above.
By following this treatment algorithm, surgeons can ensure optimal outcomes for patients undergoing axillary breast tissue removal.
Axillary breast tissue removal is a safe and effective procedure that can address the functional and cosmetic concerns associated with this condition. Depending on the specific characteristics of the tissue and the patient’s goals, various treatment options are available, including nonsurgical methods like CoolSculpting and Kybella and surgical techniques such as liposuction, BodyTite liposuction, and excision. The treatment choice should be based on an individualized assessment of the patient’s situation, considering factors such as tissue type, skin laxity, and accessory nipples. By following the treatment algorithm in this guide, surgeons can tailor their approach to achieve optimal results in axillary breast tissue removal procedures.
