Reply to comment on “Anatomical study of the breast superficial system: the inframammary fold unit” by E Riggio et al.

Reply to comment on “Anatomical study of the breast superficial system: the inframammary fold... Eur J Plast Surg (2001) 24:157 DOI 10.1007/s002380100234 AUTHOR’S REPLY E. Riggio Reply to comment on “Anatomical study of the breast superficial system: the inframammary fold unit” by E Riggio et al. Published online: 24 March 2001 © Springer-Verlag 2001 The finding that the microstructure of the female infra- perficial layer of the superficial fascia” and “inframam- mammary fold is directly connected to the superficial mary ligament” should not exist. There is only the breast fascial system is significant. There has been no previous gland with its anterior envelope (fascia mammae in work to accurately show the fine connective tissue Latin, as initially termed by the anatomists). The superfi- framework of the inframammary fold and to demonstrate cial fascia is unique, as it occurs in all parts of the trunk; its various layers from the chest wall to the skin [1]. this is very simple and easy to understand. Our histologic illustrations as well as the description The embryology is also not appreciated by many sur- of the inframammary fold fascial system are unique. geons. The breast does not develop within the superficial Nine out of nine specimens of the female inframammary fascia. The comparison with the muscles is not correct territory have demonstrated the same histologic fascial embryologically. The muscles take their origin from the framework. The cadaver observations were complemen- mesoderm while the breast is of ectodermal origin and tary but not absolutely necessary to providing an under- develops anterior to the superficial fascia, as is the situa- standing of this region, i.e., the existence of an infra- tion for all skin glands in the anterior subcutaneous lay- mammary ligament and the superficial fascia splitting at er. Muscular tissue is the only element that develops in the same level. There was no periosteal insertion of the relation to the superficial fascia. These findings are one ligament in six cadavers (12 breast dissections) and in 12 century old. I repeat, all components of the breast were live breast dissections. investigated but some new details can make a difference The anatomy of the inframammary connective struc- to surgical treatment [2]. ture has been clearly shown by photographs in the fresh I think the study is significant for the suggestion and cadaver, during breast surgery, and in histological speci- not the clinical data about this peculiar question. My mens. Direct observation of these tissues and a study of conclusion is a result of personal observation, experience the elastic and collagen fibers in the specimens have with more than 100 reconstructions of the inframammary confirmed the hypothesis. We have not truly discovered fold after mastectomy and expansion, and clinical obser- anything but have carefully looked at the anatomy of the vation of female breasts in a National Cancer Institute. inframammary region. To think that new studies of anat- This understanding of the superficial fascial system at omy of the breast on ten, 50, or 100 cases can be more the submammary fold allows us to perform the best re- precise than the anatomical research of one century ago, definition of the breast contour. I can see that those who is ingenuous. Our photographs could have been taken by do not understand this fine anatomy have not been able any surgeon; it is the correct interpretation which makes to carry out the surgical procedure correctly. the difference. We have assumed a basic knowledge of histology and anatomy by reading the complete works of anatomists. The review of the anatomic studies concern- References ing the superficial fascia is helpful. We do not add any 1. Sterzi G (1910) La fascia superficiale. In: Niccolai JP (ed) Il new nomenclature. On the contrary, such terms as “su- tessuto sottocutaneo (Tela subcutanea). Ricerche Anatomiche, Firenze pp. 62–68 This comment refers to the article which can be found at http://dx. 2. Nava M, Quattrone P, Riggio E (1998) Focus on the breast fas- cial system: a new approach for inframammary fold reconstruc- tion. Plast Reconstr Surg 102:1034–1045 E. Riggio ( ) Plastic Reconstructive Surgery Department, Istituto Nazionale per lo Studio e la Cura dei Tumori, Via Venezian 1, 20137 Milano, Italy European Journal of Plastic Surgery Springer Journals

Reply to comment on “Anatomical study of the breast superficial system: the inframammary fold unit” by E Riggio et al.

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Medicine & Public Health; Plastic Surgery
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