Scott Webb (Host): Accessory or extra breast tissue is perhaps more common than you'd think, but my guest today says, while it's totally normal, help is available if it's affecting your quality of life. I'm joined again today by Dr. Constanze Rayhrer. She's a board-certified surgeon specializing in breast surgery with Franciscan Health.

 This is the Franciscan Health Doc Pod. I'm Scott Webb. Doctor, it's so nice to have you here today. We're going to talk about accessory breast tissue and what that is and what that means. And it's good to have you here, because I don't know anything about this topic. But you're an expert, so let's dive in here. What exactly is accessory breast tissue and how does it develop?

Dr. Constanze Rayhrer: Well, that's an excellent question. And I think your experience is very similar to most people. Most people haven't heard of accessory breast tissue. I was really excited to do this podcast with you, because it's actually quite common and even people that have accessory or extra breast tissue often don't recognize what it is.

So, accessory breast tissue is something we can be born with. It's actually something that about 5% of women have, so one out of 20. And it's just a variation in our anatomy. There is an area during our development where a line that starts in the armpits and runs down the chest and towards the groin on each side, it's called the milk line. It's a developmental line. And before we are born and while we're developing, we can develop breast tissue anywhere along that line.

Now, usually, what happens is we develop breast tissue along the line. And the breast issue that develops that's not in our normal breast position tends to regress before we're born. And then, it is gone. But in about 5% of women and some men, we can have extra areas of breast tissue anywhere along that line.

Host: Do you find that folks are, let's say, surprised to learn that they have this extra or accessory breast tissue?

Dr. Constanze Rayhrer: That's the usual situation.

Host: Okay.

Dr. Constanze Rayhrer: So sometimes, accessory breast issue or extra breast issue is not really noticeable until hormones kick in. The most typical location would be under the arms.

Host: Yeah.

Dr. Constanze Rayhrer: A typical presentation is that it's first noticeable when either a woman is going through puberty, and there is breast tissue development or during pregnancy, and all of a sudden lumps show up where they weren't before because the accessory breast issue gets stimulated by hormones.

Host: Yeah. Because I was going to ask you about exactly where this is. Is it always under the armpit or is it possible that folks, men, and women could have this extra breast tissue other places?

Dr. Constanze Rayhrer: So, there is a lot of variation and it's probably one of the reasons it's not well-recognized. So, accessory breast tissue typically could form anywhere along that milk line we talked about, so anywhere from the armpit, all the way across the front of the chest and all the way down to the groin.

Now, the accessory breast tissue also can come in different combinations. We can see nipples without breast mounds. We can see breast tissue, mounds without nipples. We can see both together. Probably one of the most common presentation is extra nipples, and they're usually under the normal breast area on the chest and are often confused with just freckles. They can be very small and not very noticeable.

Host: This is a fascinating topic. It makes me wonder when and how do patients notice this? As you say, it could be something so small, it might be dismissed as a freckle. Do they really need an expert like yourself to diagnose, if you will?

Dr. Constanze Rayhrer: So usually, people don't recognize it themselves. Sometimes it can run in families a little bit. And so, sometimes a mother will recognize it when a daughter has it. Typically, men think it's a freckle. The most common presentation in men is an extra nipple, and it can be very subtle. And they find out when they go to the doctor and ask about this freckle that they have.

Women frequently develop the bulges under their arms during puberty, or particularly during pregnancy, and they didn't notice anything before that. But as the breast issue becomes engorged, there are these lumps under the arm, and it can be confused with other conditions that are more worrisome. And they go to a doctor and find out it's accessory breast issue.

The breast tissue that develops during puberty can be particularly troublesome because it can be very embarrassing for women. And I do have patients that were made fun of in the locker room for their accessory breast tissue, and also can really feel like there's a lump under the arm, like you're carrying a ball under your arm. It can be quite uncomfortable and interfere with garment wear.

Host: Yeah, I was going to ask you about that. Just it feels like it would cause some discomfort, right? I don't know if it's symptomatic or asymptomatic. But just in general, as you say, it could feel like you're carrying a ball under your arm. So, obviously, there would be or could be some discomfort.

Dr. Constanze Rayhrer: Yeah, it depends on the amount of breast tissue that's there. If it's very small, which can happen, then it's usually not that troublesome and people are just reassured to know that it's a normal variant. It's nothing really wrong with them. And if it's larger though, it can be really uncomfortable and interfere with wearing some clothing.

Host: Yeah. So, I'm trying to connect the dots here, just being a lay person, of course. But it's a glandular tissue. So, how does it then respond to hormonal changes? Does it swell? Does it become painful? Does it lactate? I got a lot of things swirling around, but does it affect the patient's quality of life?

Dr. Constanze Rayhrer: It can present with a different combination of symptoms depending on the combination of tissues the patient was born with. So, breast glandular tissue without a nipple can swell up during pregnancy and be uncomfortable. But occasionally, there will be accessory breast tissue with the glandular tissue and a nipple. And sometimes women won't notice anything until they are breastfeeding and they notice they have milk production from what they thought was a freckle typically under the arm. As the hormones stimulate the breast tissue, it can become very uncomfortable.

Host: Sure.

Dr. Constanze Rayhrer: After breastfeeding, it tends to calm down. But sometimes, it really stays quite large and people would like to have it removed.

Host: Yeah. As I think I've made it clear and perhaps listeners as well, this is all new to me. So, I'm so glad you're here to try and make some sense of this. So, it makes me wonder then, this accessory or extra breast tissue, is it possible that it carries the same risk of breast cancer as normal breast tissue?

Dr. Constanze Rayhrer: So yes, it does carry a risk of breast cancer similar to normal tissue. The accessory breast tissue, by definition, is a completely separate area from the breast. So, most of it occurs under the arm and women. And fortunately, that area actually gets included in mammograms. So, most of the time, we are imaging the accessory breast tissue as we image the normal breast tissue. So, that's the good news. If there is a tissue that would be outside of that area, yeah, we should check on it too.

Host: Is it the same screening recommendations?

Dr. Constanze Rayhrer: It would be the same screening recommendations.

Host: Okay. Yeah, it's just really fascinating. I guess it makes me wonder are there any circumstances in which you recommend intervention? And how does this work from diagnosis to possible intervention? As you say, some folks, especially women, perhaps want to have it removed or have them removed. How does all that work?

Dr. Constanze Rayhrer: Whether we remove the tissue or not, it really depends on how much it's interfering with someone's life. It is a short outpatient surgery to remove the tissue. And it's variable. You know, some people are fine as long as they know it's normal. It's a variant, but a normal variant. There's nothing really wrong with them. And it's not bothering them too much, then they're just happy to know about it and that they're okay. It can be quite large though. And in those patients, it can be removed. It's not difficult and it can be quite a relief, especially if someone has been teased or if it's been very uncomfortable. So, it's an accepted and not a rare surgery either.

Host: Right. You said 5% of women. So, it just stands to reason, you know, even if they don't all elect to have the surgery, there's going to be some of them, of course. And you've given us the reasons why: uncomfortable, affecting quality of life, embarrassment, all the above. What's the most important piece of advice you'd give someone who discovers a lump in the armpit or along the milk line, this accessory or extra breast tissue?

Dr. Constanze Rayhrer: Well, the first thing we always want to do is make sure a lump is not something more important than accessory breast tissue as far as our health. So, it's always good to check in with your doctor, check in with a breast specialist, get your imaging. But if you're not sure what something is, definitely show it to one of us so that we can help you with what it is.

If you have a family member with accessory breast tissue and it's clear that you have accessory breast tissue, I think the most important thing to know is that it needs to be checked, like all the other breast tissue that we have, but there's nothing wrong with a person that has accessory breast tissue. It's completely normal. It's just one of these things that make each one of us unique.

Host: For sure. Well, I always look forward to having you on because it never fails, I always learn something from you and we talk about some interesting topics. I hope listeners agree. I really appreciate your time, your expertise. You've given me a lot to think about and talk to my wife about today. So, thank you so much.

Dr. Constanze Rayhrer: Thank you.

Host: And for more information, visit franciscanhealth.org and search breast health. And if you found this podcast helpful, please share it on your social channels, and be sure to check out the full podcast library for additional topics of interest. This is the Franciscan Health Doc Pod. I'm Scott Webb. Stay well, and we'll talk again next time.