Cooper's ligaments

Cooper's ligaments (also known as the suspensory ligaments of Cooper and the fibrocollagenous septa) are connective tissue in the breast that help maintain structural integrity. They are named for Astley Cooper, who first described them in 1840.[1][2] Their anatomy can be revealed using Transmission diffraction tomography.[3]

This article is about Cooper's ligaments of the breast. For the inguinal structure also called Cooper's Ligament, see Pectineal ligament.
Cooper's ligaments
Dissection of human breast: Cooper's ligaments labeled as "Retinacula cutis (Ligs. of Cooper)" and "Retinacula cutis"
Details
Identifiers
LatinRetinaculum cutis mammae,
ligamenta suspensoria mammaria
TAA16.0.02.015
FMA71433
Anatomical terminology

Cooper's Suspensory Ligament should not be confused with the pectineal ligament (sometimes called the inguinal ligament of Cooper) which shares the same eponym. Also, the intermediate fibers and/or the transverse part of the ulnar collateral ligament are sometimes called Cooper's ligament(s).[4][5]

Structure

The ligaments run from the clavicle and the clavipectoral fascia, branching out through and around breast tissue to the dermis of the skin overlying the breast. The intact ligament suspends the breast from the clavicle and the underlying deep fascia of the upper chest. This has the effect of supporting the breast in its normal position, and maintaining its normal shape. Without the internal support of this ligament, the breast tissue (which is heavier than the surrounding fat) sags under its own weight, losing its normal shape and contour.

Clinical significance

The suspensory ligaments of Cooper play an important role in the change in appearance of the breast that often accompanies the development of inflammatory carcinoma of the breast in which blockage of the local lymphatic ducts causes swelling of the breast. Because the skin remains tethered by the suspensory ligaments of Cooper, it takes on a dimpled appearance reminiscent of the peel of an orange (peau d'orange). Carcinomas can also decrease the length of Cooper's ligaments leading to a dimpling.

Relationship to sagging
Main article: Ptosis (breasts)

Many women believe that sagging is caused by the failure of the Cooper's ligaments to support the breast tissue. In fact, sagging is partly determined by genetic factors, but a scientific study found that the biggest factors affecting sagging are cigarette smoking, a woman's body mass index, her number of pregnancies, the size of her breasts before pregnancy, and her age.[6]

Many women incorrectly believe that wearing a brassiere prevents their breasts from sagging later in life and that breasts cannot anatomically support themselves.[7] But bra manufacturers have stated that because breasts are formed of fatty tissue and not muscle, bras only affect the shape of breasts while they are being worn.[8][7]

Pathologically heavy breasts may cause pain in the woman's upper thoracic area, but this may be due to a poorly-fitting bra. Numerous reports state that 80–85% of women are wearing the wrong bra size.[9][10][11][12][13]

In middle-aged women, breast ptosis is caused by a combination of factors. If the woman has had children, postpartum hormonal changes will cause the depleted milk glands to atrophy. Women who experience multiple pregnancies repeatedly stretch the skin envelope during engorgement while lactating. In addition, after the birth of each child, the voluminous milk glands diminish in size, contributing further to sagging. As a woman's breasts grow in size during repeated pregnancies, the Cooper's ligaments that maintain the position of the mammary glands against the chest, are stretched and gradually lose strength. Breast tissue and suspensory ligaments may also be stretched if the woman is overweight or loses and gains weight.

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References
  1. synd/3342 at Who Named It?
  2. A. P. Cooper. On the anatomy of the breast. 2 volumes. London, Longman,1840.
  3. Simonetti F, Huang L, Duric N, Littrup P (July 2009). "Diffraction and coherence in breast ultrasound tomography: a study with a toroidal array". Medical Physics. 36 (7): 2955–65. doi:10.1118/1.3148533. PMID 19673194.
  4. http://medical-dictionary.thefreedictionary.com/transverse+ligament+of+elbow
  5. Waldeyer's Human Anatomy - Membrum superius, articulatio cubiti
  6. Campolongo, Marianne (December 5, 2007). "What Causes Sagging Breasts?". Archived from the original on 15 May 2012. Retrieved 26 January 2012.
  7. "Female Intelligence Agency: Why do women wear bras?". 007b Breast. Retrieved 10 May 2011.
  8. Cawthorne, Simon (November 2000). "Bras, the Bare Facts". Channel 4.
  9. Wood K, Cameron M, Fitzgerald K (2008). "Breast Size, Bra Fit and Thoracic Pain in Young Women: A Correlational Study". Chiropractic & Osteopathy. 16: 1. doi:10.1186/1746-1340-16-1. PMC 2275741. PMID 18339205.
  10. "Right bra 'could halt breast ops' BBC". BBC News. 11 April 2008.
  11. "Are you wearing the right bra size?". Archived from the original on 2008-09-17.
  12. Lantin, Barbara (14 April 2003). "A Weight off my shoulders". The Daily Telegraph. London. Retrieved 4 January 2011.
  13. "Rigby and Peller – Bra fitting". Archived from the original on 2013-01-04. Retrieved 2012-01-31.
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