title: Anatomy of the superficial layer of superficial fascia around the nipple-areola complex.
abstract: BACKGROUND
  The periareolar incision is the preferred method for mammaplasty because of the minimal scarring, and suturing of the superficial fascial system (SFS) is useful for avoiding hypertrophic scarring. In this report, we describe the anatomical location of the SFS around the nipple-areolar complex (NAC) and its histological structure.
  
  
  METHODS
  To define the location of the SFS, 20 healthy women were assessed by ultrasonography, and sections of the NAC of 10 female cadavers were examined under a light microscope.
  
  
  RESULTS
  Ultrasonographic examination of sagittal sections of the breast revealed a hyperdense line immediately beneath the skin, which ran parallel with the skin and turned under the NAC. At the turning point, the line thickened to an average of 3.09 mm. The distance between the nipple and the thickest point of the hyperdense line was 10.14 mm on average. Histological structures of the line were collagen and elastic fibers containing smooth muscles that were connected to the dermis and adipose tissue. At the turning point, nerves, blood vessels, and mammary ducts were irregularly observed in the area of collagen and elastic fibers. These structures were intermingled, and the fiber bundle was very thick.
  
  
  CONCLUSIONS
  The thickest area of the turning point is an area of the superficial layer of superficial fascia, which is a key structure around the NAC. The detailed anatomical data shown in our study provide good morphological landmarks for the closure of periareolar incisions.
  
  
  METHODS
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authors.affiliation: Department of Plastic and Reconstructive Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan.
authors.forename: Takako
authors.initials: T
authors.lastname: Komiya
authors.forename: Norihito
authors.initials: N
authors.lastname: Ito
authors.forename: Ryutaro
authors.initials: R
authors.lastname: Imai
authors.forename: Masahiro
authors.initials: M
authors.lastname: Itoh
authors.forename: Munekazu
authors.initials: M
authors.lastname: Naito
authors.forename: Jun
authors.initials: J
authors.lastname: Matsubayashi
authors.forename: Hajime
authors.initials: H
authors.lastname: Matsumura
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001940:Breast / Q000033:anatomy & histology* / Q000601:surgery; D005260:Female; D006801:Humans; D042361:Mammary Glands, Human / Q000033:anatomy & histology; D008875:Middle Aged; D040521:Subcutaneous Tissue / Q000601:surgery*; D016217:Ultrasonography, Mammary