Understanding the fascial supporting network of the breast: key ligamentous structures in breast augmentation and a proposed system of nomenclature.

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.

Preventing venous congestion of the nipple-areola complex: an anatomical guide to preserving essential venous drainage networks.

BACKGROUND: Venous congestion leading to partial or total nipple necrosis is a relatively uncommon complication of breast reduction and mastopexy procedures but still occurs, particularly in larger reduction procedures. This is largely preventable if the surgeon has an understanding of the venous drainage to the nipple and carefully preserves it. METHODS: An anatomical study was undertaken on 16 fresh female cadaveric breast specimens. The venous drainage of the breast was explored through vascular injection, radiographic, and cross-sectional studies. RESULTS: The venous drainage of the breast consists of an extensive network of vessels. The nipple-areola complex is drained by a superficial subareolar ring of veins that drains by means of medial and lateral veins. Laterally, superolateral and inferolateral veins drain into the subclavian veins, whereas medially, two veins drain into the internal mammary veins. An inferior vein drains the inferior quadrant of the breast in the midmammary line. Medially, the veins have a superficial course, whereas laterally, the veins follow a deeper course. CONCLUSIONS: The breast contains an extensive venous network. To avoid necrosis of the nipple-areola complex, this venous network should be preserved. The superomedial/medial and inferior pedicles contain the most extensive and more reliable venous drainage patterns.