ABSTRACT
BACKGROUND: The ligamentous system of the breast comprises a deep component, connecting the breast to the chest wall, and a superficial component, attached to the dermis and defining the breast contour. METHODS: A female patient with a family history of breast and ovarian cancer and presenting a bilateral fibrocystic mastopathy was submitted to surgical treatment with bilateral subcutaneous mastectomy and immediate reconstruction with implants. RESULTS: Intra-operatively, a strong ligament between the clavicle and the upper pole of the breast was identified. In addition, there was bilateral absence of the suspensory ligament of the axilla. CONCLUSIONS: Variations on the anatomy of the ligamentous system of the breast can represent alterations during the embryonic development of the breast and may have an important impact in the development of breast ptosis. LEVEL OF EVIDENCE V: This journal requires that the authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.