Surgical Anatomy

Abstract

3A rich nervous and vascular supply to the mammary gland and to the nipple areola complex has long been known (Cooper 1840a;Marcus 1934). In turn, the location of the neurovascular structures within the breast has always been unpredictable and appeared to be distributed in a haphazard, randomized pattern. A practical approach to locate these structures is desirable in order to ensure safe viability and sensibility of the nipple in breast surgery.Our investigations of the mammary gland showed a definite relationship between the course of the nerves and vessels and a coherent, strong suspension apparatus in the breast which can reliably be predicted and which displays a constant morphology (Würinger, Mader et al. 1998;Würinger, Tschabitscher 2003;Würinger 2009). The ligamentous suspension consists of a horizontal fibrous septum originating from the pectoralis fascia at the level of the fifth rib heading toward the nipple and its vertical ligamentous extensions which provide a medial and lateral line of fixation on either border of the septum (Fig. 1 -4).The medial vertical ligament stretches from the sternum along the second to the fifth rib, while the lateral vertical ligament attaches along the lateral border of the pectoralis minor muscle. Cranially, the vertical ligaments are connected along the second rib by the super-