Cooper suspensory ligaments of the breast are fibrous connective tissue strands running from the dermis of the breast skin through the breast parenchyma to the deep pectoral fascia, providing structural support to the breast and maintaining its shape and position. They are particularly dense in the upper breast. They are continuous from the skin to the deep fascia, dividing the breast into lobular compartments.
Suspend and support the breast tissue from the overlying skin and the underlying pectoral fascia, maintaining breast projection and shape throughout the range of arm and shoulder movement.
Cooper ligament retraction by an invading breast carcinoma produces the characteristic skin dimpling (peau d'orange) and tethering that are classical signs of breast malignancy. Tumour-induced fibrosis and shortening of these ligaments in the early stages creates subtle skin tethering visible on careful inspection with the patient in different arm positions. Skin-sparing mastectomy preserves the overlying skin while removing the gland; the Cooper ligaments attached to the skin must be divided to release the breast from the overlying skin flap.
Breast carcinoma invading and contracting Cooper suspensory ligaments produces focal skin dimpling or tethering, a clinical sign of malignancy elicited by asking the patient to raise her arms overhead or lean forward; even subtle dimpling on careful inspection warrants urgent triple assessment with imaging and biopsy.
