Suspensory ligaments of breast !

The suspensory ligaments of the breast (Cooper's ligaments) are fibrous bands that support the breast; a cancer pulling on them dimples the skin.

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What it is

Fibrous bands (Cooper's ligaments) that run through the breast from the fascia over the pectoralis major to the skin.

What it does

Hold up the breast and divide it into compartments. They stretch with age, weight changes and pregnancy, so the breast hangs lower (ptosis).

Key facts

Attaches: Dermis of the breast skin through the gland to the pectoral fascia
Function: Support the breast (Cooper's ligaments); tumour traction on them causes skin dimpling (retraction)

Relations

Course: From the pectoral fascia over the pectoralis major, through the fat and between the lobes, to the dermis of the skin
Deep: Pectoral fascia, across the retromammary space
Superficial: Dermis of the breast skin, where they anchor

How to find it

Not felt as separate bands. In a dissection, or when skin flaps are raised in a mastectomy, they appear as fibrous strands running up from the tissue over the lobes into the dermis, dividing the fat into compartments; they have to be cut to free the skin.

Examination

Inspection with the arms raised and with the hands pressed on the hips: a dimple or a flattened contour appears as the ligaments are put under tension
Gently lifting or moulding the breast around a lump: puckering of the skin above it shows tethering

On imaging

On ultrasound and mammography they are thin curved lines between the fat lobules; thickened, straightened or retracted ligaments near a mass suggest infiltration, and architectural distortion is a recognized mammographic sign of cancer.

Common problems

A cancer that pulls on these ligaments draws the skin in: a dimple (skin retraction), a warning sign.
Stretched ligaments: a sagging breast (ptosis).

How it is diagnosed

Looking at the breasts with the arms raised shows a dimple; mammography and ultrasound look for a mass beneath it.

Treatment

Ptosis: a supportive bra, or a breast lift (mastopexy).
A dimple from a cancer is treated with the cancer.

Clinical notes

Breast ptosis is graded by where the nipple sits relative to the inframammary fold
Inflammatory breast cancer causes redness, warmth and peau d'orange over much of the breast and can be mistaken for mastitis
The same skin dimpling can follow fat necrosis or surgery, which is why imaging and biopsy decide the cause

Test yourself

Think of the answer, then tap the question to see it.

What does skin dimpling over a breast lump mean?

A tumour is pulling on the suspensory ligaments (Cooper), even when the lump itself is small.

What causes peau d'orange, and which cancer is it a hallmark of?

Blocked dermal lymphatics: swollen skin bulges between pores still tethered to it; a hallmark of inflammatory breast cancer.

Where do the suspensory ligaments of the breast attach?

From the pectoral fascia over the pectoralis major, through the gland and fat, to the dermis of the breast skin.

How is a subtle dimple from suspensory ligament tethering brought out on inspection?

With the arms raised and with the hands pressed on the hips, which puts the ligaments under tension.

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Educational information, not medical advice. For any symptom, see a health professional.

Its names

Official Latin (TA2): ligamenta suspensoria mammaria TA2 7109
Official Spanish (DeCS): Ligamentos suspensorios de la mama
English (TA2): Suspensory ligaments of breast
Also called: suspensory retinaculum of breast · ligamenta suspensoria mammae · cooper’s ligaments

Sources: Terminologia Anatomica (TA2); Anatomy, Thorax, Breast; Anatomy, Thorax: Mammary Gland; 27.2 Anatomy and Physiology of the Ovarian Reproductive System (OpenStax (Rice University), 2022) · adapted, CC BY 4.0.

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Representative model, for educational purposes only.