Cooper's ligaments (also known as the suspensory ligaments of Cooper and the fibrocollagenous septa) are

connective tissue Connective tissue is one of the four primary types of animal tissue, along with epithelial tissue, muscle tissue, and nervous tissue. It develops from the mesenchyme derived from the mesoderm the middle embryonic germ layer. Connective tiss ...

in the breast that help maintain structural integrity. They are named for Astley Cooper, who first described them in 1840. Their anatomy can be revealed using Transmission diffraction tomography. 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).

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 Inflammatory breast cancer (IBC) is one of the most aggressive types of breast cancer. It can occur in women of any age (and, extremely rarely, in men, see male breast cancer). It is referred to as "inflammatory" due to its frequent presentation w ...

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 Peau d'orange (French for "orange peel skin" or, more literally, "skin of an orange") describes a phenomenon in which hair follicles become buried in edema, giving the skin an orange peel appearance. Peau d'orange can be caused by cutaneous lymph ...

). Carcinomas can also decrease the length of Cooper's ligaments leading to a dimpling.

Relationship to sagging

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 Body mass index (BMI) is a value derived from the mass (weight) and height of a person. The BMI is defined as the body mass divided by the square of the body height, and is expressed in units of kg/m2, resulting from mass in kilograms and he ...

, her number of

pregnancies Pregnancy is the time during which one or more offspring develops ( gestates) inside a woman's uterus (womb). A multiple pregnancy involves more than one offspring, such as with twins. Pregnancy usually occurs by sexual intercourse, but can ...

, the size of her breasts before pregnancy, and her age. Many women incorrectly believe that wearing a brassiere prevents their breasts from sagging later in life and that breasts cannot anatomically support themselves. 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. 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. In middle-aged women,

breast ptosis The breast is one of two prominences located on the upper ventral region of a primate's torso. Both females and males develop breasts from the same embryological tissues. In females, it serves as the mammary gland, which produces and secret ...

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 Lactation describes the secretion of milk from the mammary glands and the period of time that a mother lactates to feed her young. The process naturally occurs with all sexually mature female mammals, although it may predate mammals. The proces ...

. 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.

References

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