Should I Have Axillary Tissue Removed with my Breast Reduction?

My PS is convinced the axillary is primarily breast tissue and is concerned that lipo will not leave a good result. He would prefer to do the BR first and then see, but he does not believe the BR is likely to reduce them. Also he's charging a lot for the axillary removal. Should I push to do both together? Should i Do the BR alone and then Explore other PS options for the axillary removal. My PS is VERY experienced and has a fabulous reputation so I am concerned by his reluctance.

Doctor Answers 11

Axillary tissue removal at breast reduction surgery

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I would take a different view than most of my colleagues who have commented so far.

It's not clear exactly what you mean by axillary tissue however. You may mean one of the following:  Accessory breast tissue (extra breast tissue just at the top front edge of your armpit), a large axillary tail of your breast (so the breast looks wide based, even sometimes to right under the arm), or just a fatty axilla, separate to the breast itself. 

In any of these instances, it's very safe to remove the excess tissue at the time of breast reduction, usually through a combination of liposuction and surgical removal.  Sometimes (often in my practice) it can be removed by lipo alone, with the aspirate sent for pathologic sampling.

The blood supply to the nipple comes from the inner not the outer side so is not at all compromised.  Indeed, debulking the wide outer side of the breast reduces tension on closure and probably reduces risk to the nipple.

In my opinion, addressing the axilla is an important and integral part of a good breast reduction.  It's hard to make a good shape without addressing it, actually.

From a cost point of view every surgeon charges differently.  In my own practice, it costs no more to have the axilla addressed at the operation.  It is, as I see it, all part of a breast reduction.

All the best.

Reducing Axillary Fullness with Breast Reduction

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Axillary fullness can be due to several things. The hardest to deal with during breast reduction is actually breast tissue in what is known as the "Tail of Spence," an extension of the breast itself toward the axilla. Frequently, however, the fullness is fat, either alone or over the axillary extension of the breast. Liposuction can generally remove the excess fat and, in many cases, flatten the area. If the fullness is breast tissue, then the only way to flatten it is to resect it. To do this, one must be careful not to reduce the blood supply to the lateral part of the breast in order not to risk tissue loss or markedly delayed healing. This may require a staged approach. If your Plastic Surgeon truly very experienced, trust him/her. His/her job is to get you the best result with the least risks.

Robert T. Buchanan, MD
Highlands Plastic Surgeon

Axillary breast tissue

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While I cannot tell you what to do since I have not examined you, it is not uncommon to remove redundant axillary breast tissue at the same time as the breast reduction. Since this breast tissue is often glandular rather than fat, liposuction by itself is not that effective. The skin can also be rather redundant and hang loosely if not excised so a direct excision with removal of the redundant skin is often required.  Perhaps your surgeon is reluctant to create a new scar that can be visible in dark-skinned patients and he might try to reduce it with liposuction through the breast reduction incision to see how much reduction he can achieve with this method first. Certainly your trust in him is paramount and you should have a frank discussion with him regarding options and risks.

Robin T.W. Yuan, M.D.

Robin T.W. Yuan, MD
Beverly Hills Plastic Surgeon

Breast Reduction and axillary liposuction

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Without examination and photos its best to trust your experienced plastic surgeon who has an excellent reputation. You can always reassess this area following surgery and determine if it makes sense to undergo liposuction once you have healed from your reduction.    

Jason S. Cooper, MD
Jupiter Plastic Surgeon

Breast Tissue Removed

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We see this very commonly with breast reduction.  It may be satisfactory to perform liposuction at the time of breast reduction. This may solve the issue and it can always be excised if needed. goog luck

Miguel Delgado, MD
San Francisco Plastic Surgeon
4.8 out of 5 stars 81 reviews

Excess Axillary Tissue Done Together Or Separate from Breast Reduction

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There are arguments to be made for simultaneous vs. staged axillary breast tissue removal at the time of a breast reduction. The only reason to stage it, and a really good reason, is that it may injure the blood supply to the skin flaps of the breast reduction. The risk of that depends somewhat on the technique used to remove it. Liposuction extraction diminishes that risk while an open incisional approach increases it. Your plastic surgeon's reluctuance to do them together should be a sign that there is a good reasonk for staging and that he/she is looking out for your best interest. 

Breast and axillary tissue reduction

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When performing a breast reduction, the lateral flap of skin closed obtains its blood supply  from the lateral and superior tissue. If you excise the axillary tissue at the same time, it may compromise the survival of that skin.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

Removal of axillary tissue

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It is common for patients to have both excess axillary tissue and macromastia. However, I perform the breast reduction first and then operate on the axillae at a later date. The reason is that working in the axilla can compromise the blood supply to the flaps and increase the risk of nipple/areolar slough, among other things. Your plastic surgeon is taking the conservative and, in my opinion, appropriate course here. Liposuction is not the treatment of choice for breast tissue as opposed to excess fat.

Should I Have Axillary Tissue Removed with my Breast Reduction?

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Although it is worthwhile to seek opinions online, you seem to understand the situation and your choices well.  Many patients want this extra axillary tissue removed at the time of breast lift or breast reduction.  It can be done, but is extra time, effort, and risk superimposed upon an already demanding procedure.

Steve Laverson, MD
San Diego Plastic Surgeon
4.9 out of 5 stars 50 reviews

Combining Cosmetic and Insurance Procedures

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    The breast reduction can be approved by insurance, and cosmetic surgery can be combined in addition to get a break on anesthesia and facility fees.  This is not impossible and is done frequently.   Your plastic surgeon probably has a good reason why he does not want to perform this second procedure.  If you trust him, trust his opinion. Good luck.

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.