The Hidden Skeleton: How “Würinger’s Septum” Revolutionized Breast Reduction Surgery
The Discovery in Vienna
Before the late 90s, breast anatomy was often viewed simply as a mass of glands and fat. Surgeons knew where the blood vessels generally were, but the internal “architecture” was not fully mapped.
In April 1999, Dr. Elisabeth Würinger published a groundbreaking study in Plastic and Reconstructive Surgery based on her work at the Wilhelminenspital in Vienna, Austria. Through meticulous dissection of 20 female breasts, she discovered a distinct connective tissue structure that acts as a “suspension apparatus” for the breast.
This structure is now known globally as Würinger’s Septum.
What is the Ligamentous Suspension?
Dr. Würinger found that the breast is not just a loose bag of tissue. It has a constant, definable internal structure:
- The Horizontal Septum: A strong band of tissue that originates at the level of the 5th rib.
- The Curve: This septum curves upward, turning into vertical medial and lateral ligaments.
- The Superhighway: Most importantly, this septum acts as a “guide,” carrying the main blood vessels and nerves directly to the nipple.
The Technique: Refined Central Pedicle
Using this new anatomical map, Dr. Würinger refined the Central Pedicle technique. Instead of relying on the skin to carry the blood supply (dermal pedicle), this method relies entirely on the internal ligaments.
1. Maximum Sensation & Safety
Because the septum contains the primary nerve supply, keeping it intact provides a “predictable and reliable” way to preserve nipple sensation. It also guarantees blood flow, making the surgery safe regardless of the patient’s risk factors or the size of the reduction.
2. True Symmetry
The study revealed that the horizontal septum divides the breast into regular, measurable sections. Surgeons can use this septum as a built-in ruler, ensuring that the left breast matches the right breast internally, not just externally.
3. Better Shape, Smaller Scars
Because the blood supply comes from deep inside (the septum) rather than the skin, the surgeon does not need to leave a thick bridge of skin attached to the nipple. This allows for:
- Smaller Scars: The skin can be tightened more effectively.
- Better Projection: The ligaments maintain their “suspending function,” acting like an internal bra to hold the shape long-term.
Conclusion
Dr. Würinger’s work proved that understanding the breast’s “ligamentous suspension” allows for safer, more precise Breast Reduction surgery. For patients, this translates to a lower risk of complications, better nipple sensation, and a more natural, perky shape that lasts.
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Frequently Asked Questions (FAQ)
Q: Is this technique used today?
A: Yes. The “Septum-Based” or “Würinger’s Septum” technique is considered one of the most anatomically sound methods in modern plastic surgery, used for both reductions and lifts.
Q: Does this help with very large breasts?
A: Absolutely. The study explicitly states that this approach allows for safe resections “irrespective of the amount of resection,” making it ideal for patients with gigantomastia.
Q: Why does the septum matter for sensation?
A: The septum acts as a conduit (protective tunnel) for the anterior branch of the 4th lateral intercostal nerve, which provides the primary feeling to the nipple. If the septum is saved, the nerve is saved.
