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Mnemonic

Cooper's Ligaments and Skin Dimpling

A memory aid for the suspensory ligaments of the breast and the sign they produce.

Anatomy Thorax
Expansion

Fibrous septa from the dermis to the pectoral fascia that tether the breast

Expansion

Cooper’s suspensory ligaments run from the dermis of the overlying skin, through the breast, to the pectoral fascia. They support the breast against gravity and divide it into lobules.

  • Tethering and dimpling - a carcinoma invading a ligament shortens it and pulls the skin inwards
  • Peau d’orange - lymphatic obstruction causes dermal oedema, but the skin stays anchored at each ligament, giving the pitted orange-peel appearance
  • Nipple inversion - a tumour tugging on the ducts and ligaments near the nipple

All three classic skin signs of breast malignancy therefore come from the same mechanical fact: the skin is tethered to deeper structures at many discrete points.