Breast dimpling, a visible indentation or puckering of the skin on the breast, can be a concerning physical change. While not every instance of breast dimpling indicates a serious condition, it is a symptom that consistently warrants professional medical evaluation. Prompt assessment by a healthcare provider ensures an accurate diagnosis and appropriate management.
Understanding Breast Dimpling
Breast dimpling appears as tiny indentations, a sunken area, or a rough, uneven texture on the breast skin, often described as resembling an orange peel, known as “peau d’orange”. The action of raising the arms can make dimpling more apparent because it stretches the skin and internal structures of the breast.
The breast’s structure includes Cooper’s ligaments, fibrous bands that connect the skin to the deeper fascia of the chest wall, providing support and shape. When the arm is raised, the pectoralis muscles tighten, pulling on these ligaments. If an underlying issue, such as a mass or inflammation, causes these ligaments to shorten or become infiltrated, they can retract the skin inward, making the dimple visible or more pronounced during this movement.
Causes of Breast Dimpling
Breast dimpling can stem from several underlying conditions, ranging from benign changes to more serious concerns. A primary concern is breast cancer, particularly inflammatory breast cancer (IBC), a rare but aggressive form that accounts for 1% to 5% of all breast cancer diagnoses.
In IBC, cancer cells block the lymph vessels in the skin, leading to fluid buildup and a thickened, dimpled appearance. Other breast cancer types, such as invasive ductal carcinoma and lobular breast cancer, can also cause dimpling when a tumor grows and pulls on the surrounding Cooper’s ligaments, tethering the skin inward.
Benign conditions can also lead to breast dimpling. Fat necrosis occurs when fatty breast tissue is damaged and dies, often following trauma, surgery, or a biopsy. This can result in a firm lump and dimpling if the damaged tissue is close to the skin’s surface. While fat necrosis is not cancerous and often resolves on its own, its symptoms can mimic a tumor.
Breast infections, such as mastitis, can also cause dimpling. Mastitis, common in breastfeeding women, involves inflammation and swelling of breast tissue, which can lead to skin changes like redness, warmth, and dimpling. Scar tissue from previous breast surgeries or injuries can similarly pull on the skin, creating indentations.
Fibrocystic changes, a common benign breast condition, involve lumpy or rope-like breast tissue that can sometimes be associated with dimpling. These changes are often linked to hormonal fluctuations and may cause tenderness or pain.
When to Seek Medical Attention
Any new or unexplained breast dimpling should be promptly evaluated by a healthcare professional. This is important if the dimpling persists, worsens, or is accompanied by other breast changes. Other concerning symptoms include a new lump, breast pain, redness, swelling, unusual nipple discharge, or a nipple that has turned inward.
Avoid self-diagnosis, as many conditions can cause breast dimpling. Consulting a doctor ensures accurate assessment and timely intervention. Early detection of underlying issues, especially breast cancer, improves treatment outcomes. Contact your primary care physician or gynecologist to discuss any breast changes.
Diagnostic Steps and What to Expect
Upon reporting breast dimpling, a healthcare provider will typically begin with a clinical breast exam, which involves a physical inspection of the breasts, often with arms raised, and palpation to feel for any lumps or abnormalities. Following this initial assessment, imaging tests are commonly ordered to investigate the cause of the dimpling.
A diagnostic mammogram is often performed, providing detailed X-ray images of the breast tissue. This differs from a routine screening mammogram and focuses on the area of concern, often including specialized views. Breast ultrasound may also be utilized, using sound waves to create images that can help differentiate between fluid-filled cysts and solid masses. In some cases, a breast MRI might be recommended, particularly for further evaluation of dense breast tissue or complex findings.
If imaging tests reveal suspicious findings, a breast biopsy may be necessary to obtain a definitive diagnosis. Several biopsy types exist, including fine needle aspiration (FNA), which removes fluid or cells with a thin needle, and core needle biopsy, which extracts small tissue cylinders with a larger needle. These procedures are often guided by ultrasound or mammography to ensure accuracy. A surgical biopsy, where part or all of a suspicious area is removed, may also be performed. The tissue samples obtained during a biopsy are then examined under a microscope by a pathologist to determine if cancerous cells are present.