Breast ligaments: an anatomical study

Abstract

Background Although the anatomy of the breast, and in particular the ligamentous system, has been widely studied for decades, there is still some controversy regarding some specific anatomical structures. The aims of this study were the ligamentous anatomy of the female breast through cadaveric dissection and to establish relationships with anthropometric and physiological data. Methods At the National Institute of Legal Medicine, we developed a protocol of cadaveric dissection in order to study the ligamentous anatomy of the breast. We performed the dissection of seven female cadavers (14 breasts). Results In each analyzed breast, the Cooper ligaments, suspensory ligament of the axilla, horizontal septum, and the inframammary ligament were recognized. We performed a statistical comparison between height and other parameters, including humeral length, distance between the suprasternal notch and the nipple, and suspensory ligament length. Conclusions This study allowed a greater understanding about the precise location of the different mammary ligaments using anatomical landmarks, including bony structures, and it confirmed that the inframammary ligament is present and related to the inframammary fold. This structure has been consistently identified in a constant anatomic position, and it is more frequently found at the level of the fifth rib. Level of Evidence: Not ratable.

The fibro‐adipose structure of the female breast: A dissection study

“…Consistent with Hypothesis 3 and previous research (Cooper, ; Cardoso et al, ; Matousek et al, ; Rehnke et al, ), the walls of the pockets were formed by what Cooper named the anterior and posterior extensions (Cooper, , ). Multiple anterior extensions were found to run from the anterior lamellae to the dermis, which varied in length from the midline to either side of the breast (Table ).…”

“…In one figure caption, the length of the extensions anterior to the corpus mamma were reported to range from 0.5 to 2.5 cm (Cooper, 1840b) and the number and size of the fibro-adipose tissue pockets located anterior to the corpus mamma were described to be less numerous yet larger than those located posterior. Cooper did not describe the existence of any pockets peripheral to the glandular tissue, however, recent research has (Cardoso et al, 2014;Matousek et al, 2014;Rehnke et al, 2018). The fibro-adipose tissue pockets located anterior to the corpus mamma have also recently been described to be 2-3 times larger than those posterior, with a 2-3 mm layer of subcutaneous tissue superficial to them (Rehnke et al, 2018).…”

“…Since Cooper (1840a), only seven cadaveric dissection studies have specifically investigated the fibroadipose structure of the breast (Lockwood, 1991;Muntan et al, 2000;Riggio et al, 2000;Jinde et al, 2006;Cardoso et al, 2014;Matousek et al, 2014;Rehnke et al, 2018). The organization of the fibro-adipose structure of the breast into fibro-adipose pockets located anterior, posterior and peripheral to the corpus mamma has been confirmed (Cardoso et al, 2014;Matousek et al, 2014;Rehnke et al, 2018); however, detail of the number or actual size of the pockets is yet to be published. This lack of detail has resulted in inconsistencies in anatomical illustrations of the breast (Riggio et al, 2000;Matousek et al, 2014;Rehnke et al, 2018), which have mainly been in the mid-sagittal plane of the breast.…”

“…This lack of detail has resulted in inconsistencies in anatomical illustrations of the breast (Riggio et al, 2000;Matousek et al, 2014;Rehnke et al, 2018), which have mainly been in the mid-sagittal plane of the breast. There have also been variations in the existence, name and location of Cooper's anterior lamellae and posterior lamellae and their extensions (Lockwood, 1991;Muntan et al, 2000;Riggio et al, 2000;Jinde et al, 2006;Cardoso et al, 2014;Matousek et al, 2014;Rehnke et al, 2018), such as "Cooper's ligaments," which have been described in Step 1: The perimeter of the breast was palpated and outlined around the entire circumference of the breast, with sites marked at 2-3 cm intervals (= stars on photo). Each site was then injected perpendicular to the skin with a 1 ml streak of viscous dye mix of 1:10 India Ink (Black Ink, Windsor and Newton©, UK) and ultrasound gel (Aquasomic© 100, Parker Laboratories, Fairfield, NJ 07004 USA) to the depth of the anterior chest wall.…”

“…These differences may be attributed to differences in the methodology of the studies effecting the visualization of the intricate fibro-adipose structure, compared to the meticulous sharp and blunt dissections conducted in the coronal plane by Cooper. Methodologies have varied from en bloc dissection or surgical techniques (Lockwood, 1991;Muntan et al, 2000;Riggio et al, 2000;Jinde et al, 2006;Cardoso et al, 2014;Matousek et al, 2014;Rehnke et al, 2018), dry liposuction (Cardoso et al, 2014), sagittal and transverse plane slices of the breast (Lockwood, 1991;Muntan et al, 2000;Matousek et al, 2014) and chemical dissection (Matousek et al, 2014).…”