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 not true ligaments but condensations of the superficial fascial system. They are particularly dense in the upper breast and divide the gland into lobular compartments.
| Origin | Deep pectoral fascia |
|---|---|
| Insertion | Dermis of the skin overlying the breast |
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.
Shortening of Cooper ligaments by an infiltrating breast carcinoma produces skin dimpling and tethering, a classical sign of malignancy best seen with the arms raised or the patient leaning forward. Peau d'orange is a different sign, caused by tumour blocking dermal lymphatics, with skin oedema around tethered hair follicles. Any new dimpling warrants urgent triple assessment. In skin-sparing mastectomy the ligaments are divided close to the skin to free the gland while keeping the skin envelope for reconstruction.
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.
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