title: A Study of Evaluation and Management of Rare Congenital Breast Diseases.
abstract: BACKGROUND
  Polymastia and polythelia may be asymptomatic or cause pain, restriction of arm movement, milk discharge, cosmetic problems or anxiety. Cosmesis is the main indication for surgical excision of accessory breasts in axilla. In addition it also confirms the diagnosis and allays the patient's fear of harbouring a malignancy.
  
  
  OBJECTIVE
  To evaluate the presentation of symptoms, investigations required for diagnosis and the management to improve the treatment protocols in patients with breast diseases.
  
  
  METHODS
  This retrospective study on breast diseases presenting as supernumerary breasts and nipples was conducted in the Department of Surgery between January 2013 and January 2016 at MMIMS Research and hospital, Mullana, Ambala. Patients were evaluated for breast diseases, either benign or malignant in both genders. A total of 32 cases diagnosed as accessory breasts disease were retrieved from the hospital archive. The clinical and radiological evaluation was done in the form of ultrasound and mammography wherever necessary. Accessory breast tissues were excised under general anesthesia and histopathological examinations were done.
  
  
  RESULTS
  Out of 32 cases: 1(3.125%) male patient had unilateral and 1(3.125%) male had bilateral accessory nipple, 7 (21.87%) females had unilateral and 1(3.125%) had bilateral accessory nipple, 1 (3.125%) diagnosed as accessory axillary fibroadenoma in female, 16(50%) presented as unilateral and 5 (15.62%) had bilateral swelling in the axilla as accessory breast. Patients underwent surgical excision and in 8(25%) cases z- shaped incision was made in view of better cosmesis. Patients were followed up upto 6 months postoperatively. There were no residual swelling and movements of the arm over the shoulder joint were normal. In 3(9.37%) cases, wound dehiscence occurred; in 2 (6.25%) cases lymphoedema formation was seen. These were successfully managed conservatively.
  
  
  CONCLUSIONS
  As breast swellings either fibroadenoma or carcinoma are common entities to come across everywhere but accessory breasts are rarely encountered especially in rural areas because of less awareness. The study found that there was tendency to neglect the swelling as there were minimal symptoms present. We also came across a rare entity, accessory breast and accessory nipples. A clinician should not ignore such cases taking as simple swelling because of chances of discovering a malignancy can occur.
authors.affiliation: Professor, Department of Surgery, M.M. Institute of Medical Sciences and Research , Mullana, Ambala, Haryana, India .
authors.forename: Rikki
authors.initials: R
authors.lastname: Singal
authors.affiliation: Associate Professor, Department of Surgery, M.M. Institute of Medical Sciences and Research , Mullana, Ambala, Haryana, India .
authors.forename: Sudhir Kumar
authors.initials: SK
authors.lastname: Mehta
authors.affiliation: Professor, Department of Patholgy, M.M. Institute of Medical Sciences and Research , Mullana, Ambala, Haryana, India .
authors.forename: Jyoti
authors.initials: J
authors.lastname: Bala
authors.affiliation: Assistant Professor, Department of Surgery, M.M. Institute of Medical Sciences and Research , Mullana, Ambala, Haryana, India .
authors.forename: Muzzafar
authors.initials: M
authors.lastname: Zaman
authors.affiliation: Professor and Head, Department of Radiodiagnosis and Imaging, M.M. Institute of Medical Sciences and Research , Mullana, Ambala, Haryana, India .
authors.forename: Amit
authors.initials: A
authors.lastname: Mittal
authors.affiliation: Head of the Department, Department of Surgery, M.M. Institute of Medical Sciences and Research , Mullana, Ambala, Haryana, India .
authors.forename: Guarav
authors.initials: G
authors.lastname: Gupta
authors.affiliation: Head of the Department, Department of Gynaecology and Obstrectics, M.M. Institute of Medical Sciences and Research , Mullana, Ambala, Haryana, India .
authors.forename: Samer
authors.initials: S
authors.lastname: Rudra
authors.affiliation: Assistant Professor, Department of Radiodiagnosis and Imaging, M.M. Institute of Medical Sciences and Research , Mullana, Ambala, Haryana, India .
authors.forename: Samita
authors.initials: S
authors.lastname: Singal
keywords: Accessory breast; Axilla; Lymph node; Malignancy; Milk line; Nipple