[Applied anatomy of the breast: blood supply and innervation]

Convinced of the importance of a precise understanding of anatomy in modern surgery, the author studied the arterial blood supply and venous and lymphatic drainage and re-evaluated the innervation of the mammary gland; 60 fresh cadavers, 350 thermographies and 5 in vivo arteriographies were analysed. Twenty years of surgical practice either supported or contradicted these anatomical findings. Schematically, the arterial blood supply is ensured by three plexuses: cutaneoglandular plexus, retroglandular plexus, intraglandular anastomotic plexus; the cutaneoglandular plexus corresponds to a combination of the dermal and the glandular blood supplies. The ectodermal embryological origin of the mammary gland clearly accounts for this common blood supply. This concept allowed the development of deepithelialised periareolar pedicle reduction mammaplasty and acts as a guide for subcutaneous mastectomies. The retroglandular plexus is supplied, in particular, by the musculocutaneous and, in this case, musculoglandulocutaneous arteries. This plexus ensures the blood supply of the remaining gland following posterior or inferior pedicle reduction mammaplasty techniques. The venous drainage was studied in particular detail. Two venous plexuses are present: one runs parallel to the arterial blood supply and the other is superficial, subcutaneous and anastomotic not only with the deep plexus, but also with the all of the surrounding regions. This plexus, quiescent under normal conditions, becomes functionally important in certain pathological conditions or after correction of mammary hypertrophy. The external and internal pathways of lymphatic drainage have been described for a long time. The authors describe the lesser known accessory pathways which nevertheless play an essential role in certain forms of metastatic spread or recurrence of breast cancer. Lastly, the authors describe the sensory innervation of the mammary gland which is an essential element for preservation of nipple sensitivity, in particular, following reduction or augmentation mammaplasty or even breast reconstructions.