Background: Under the magnification and gasification effects of the endoscope, the breast fascia and ligaments can be clearly identified. However, the anatomical theory of the breast fascia system under endoscopy is rare.
Methods: The fascia system of the breast was studied in 165 breasts from 120 patients with endoscopic mastectomy (endoscopy-assisted or robot-assisted procedures in 108 and 12 patients, respectively) and 127 breasts from 64 patients with reduction mammaplasty.
Results: The superficial fascia and ligaments were visualized stereoscopically and clearly under the endoscope. By repeatedly observing the endoscopic videos of 120 patients, we found that the percentage of the medial suspensory ligament and lateral suspensory ligament were 60% and 76.3%, respectively. The horizontal septum accounts for 74.5% and the vertical septum for 47.9%. The Cooper ligament, the inframammary fold, the perimeter, and the superficial fascia around the nipple-areola complex could be clearly displayed. We also have observed that endoscopic mastectomy is a surgical procedure that involves separating the breast from the posterior to the anterior space, beginning with the perimeter around the breast followed by the nipple-areola complex in the central area, which represents an inverse dissection pathway relative to embryonic breast development.
Conclusions: The peripheral-to-central approach of breast fascia anatomy under endoscopy improves the comprehension of breast fascia anatomy, guiding the surgeon to fully understand and perform endoscopic mastectomy in strict accordance with the anatomical integrity of the fascia.
Copyright © 2025 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons.