Understanding the Fascial Supporting Network of the Breast

Background: The fascial system of the breast has, to date, only been described in general terms. This anatomical study has developed two distinct methods for better defining existing breast structures such as the inframammary fold, as well as defining previously unnamed ligamentous structures. Methods: The authors harvested and examined 40 frozen, entire chest wall cadavers. Initially, 15 embalmed cadavers were studied with a combination of blunt and sharp dissection, which proved to be inaccurate. A further 20 fresh and five embalmed chest walls were harvested, frozen, and then sectioned with a bandsaw (3-cm slices) and knife (1.5- to 4-cm slices) depending on the area studied. Sagittal, horizontal, and oblique sections along the length of the ribs were created and then dissolved using either sodium hydroxide or alcohol dehydration followed by xylene immersion. Constant fascial connections between the breast parenchyma, superficial fascia, pectoralis muscle (deep) fascia, and bone were observed. Results: Specimens clearly demonstrated internal structures responsible for the surface landmarks of the breast. The precise configuration of the infra mammary fold was clearly visible, and new ligamentous structures were identified and named. Conclusions: Knowing the location and interrelationship of these structures is particularly important in breast augmentation. Reappraisal of the anatomy in this area has enabled precise identification of ligamentous structures in the breast. Correlation of the findings in this article to specific clinical conditions or modes of treatment can be proven only by a clinical series that scientifically addresses the necessity and efficacy of preserving, releasing, or repositioning any of these structures.