Cooper's ligaments

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Cooper's ligaments
Latin	retinaculum cutis mammae, ligamenta suspensoria mammaria

Cooper's ligaments (also known as the suspensory ligaments of Cooper and the fibrocollegenous septa) are connective tissue in the breast that helps maintain structural integrity. The ligaments run from the clavicle and the clavi-pectoral 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.

Controversy exists about the role of the brassiere, lactation, breast size and exercise in damaging these ligaments. It has been suggested that the use of the brassiere in the years before pregnancy and lactation result in atrophic weakening of these ligaments as a result of their not being subject to normal weight-bearing loads, particularly in menarchal and post-menarchal girls. On the other hand, pregnancy, lactation, sports and exercise are times when these ligaments may become stretched beyond their elastic limits and cease providing their support to the breast, resulting in the sagging, pendulous breast described above. Therefore, it would seem prudent to use a brassiere during these times only, to protect these ligaments against attenuation, and thus preserve the breast's normal contour. Pathologically heavy breasts are well known to cause pain in the upper thoracic/clavicular area which is a warning sign from nerve receptors in these ligaments that they are being stretched beyond their tolerance. In such cases, use of a brassiere may relieve some of the pain at the expense of ligament disuse atrophy. Reduction mammoplasty offers a solution to this dilemma.

For the pendulous breast with non-functional ligaments the best option is external support by a brassiere. Surgical efforts to repair or reconstruct these ligaments may produce temporary re-suspension, but the repairs usually stretch out and fail with a year.

Cooper's Suspensory Ligament should not be confused with the pectineal ligament (sometimes called the inguinal ligament of Cooper) which shares the same eponym.

[edit] Pathology

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.

[edit] Cultural references

In popular culture they are often erroneously blamed for causing the sagging of the breast in the mature and older woman. Samuel Shem (author of the "House of God") called them "Cooper's Droopers", referring to a lack of tension.