Breast dimpling is a physical symptom characterized by a visual alteration in the smooth texture of the breast skin, signifying an underlying change within the breast tissue. This change, which manifests as a retraction or indentation of the skin, warrants immediate attention from a healthcare provider. The skin’s surface moves from being taut and uniform to having an appearance that is visibly uneven.
The Visual Appearance of Dimpling
Dimpling appears as small pits, depressions, or indentations on the breast surface, making the skin look puckered or rough. The skin may seem to be pulled inward, creating a sunken appearance over a localized area. This uneven texture is often likened to the skin of a citrus fruit, which is why the medical term Peau d’orange is frequently used to describe the appearance.
Peau d’orange is a French phrase that translates to “orange peel skin.” This term describes a specific presentation where the skin is thickened and pitted with enlarged pores because the breast skin becomes edematous, or swollen with fluid. The severity of the dimpling can range from a subtle pucker only noticeable when the arm is raised to a widespread, coarse texture covering a significant portion of the breast.
Non-Malignant Causes of Skin Dimpling
While often associated with serious disease, breast dimpling can result from several common, non-cancerous conditions. One frequent cause is fat necrosis, a benign condition that develops when an area of fatty breast tissue becomes damaged and dies. This damage can occur following trauma, such as an injury from a seatbelt, or as a side effect of medical procedures like breast surgery, radiation therapy, or a biopsy.
The dead fat cells in fat necrosis can release oily fluid, sometimes forming an oil cyst, or they can eventually form firm scar tissue. If this scarred or damaged tissue is near the skin’s surface, the retraction and hardening can pull the overlying skin inward, creating a dimple. Scarring from previous breast procedures, such as reductions or lumpectomies, can also cause local tissue retraction. Any new skin change requires a medical evaluation to confirm the exact nature of the underlying tissue alteration.
Dimpling as a Sign of Serious Disease
Dimpling becomes a sign of serious disease when it is caused by the physical effects of a growing malignancy within the breast tissue. In some cases, a tumor growing deep inside the breast can invade or shorten the Cooper’s ligaments. These ligaments are a network of connective tissue fibers that run from the chest muscle fascia through the breast to attach to the skin, providing structural support.
As the tumor grows and infiltrates these ligaments, it creates a tethering effect that pulls the skin toward the mass. This mechanical tension causes the characteristic localized dimpling or puckering on the surface. This type of skin retraction can sometimes be subtle, only becoming apparent when the patient raises their arm or when the clinician gently manipulates the breast tissue during an examination.
A different, more diffuse type of dimpling is a hallmark of Inflammatory Breast Cancer (IBC), a rare but aggressive form of the disease. IBC does not typically form a distinct lump but instead causes cancer cells to block the lymphatic vessels within the breast skin. This blockage prevents the normal drainage of lymph fluid, leading to lymphedema, which causes the skin to swell, thicken, and become pitted. The resulting widespread, prominent pitting across the breast is the classic Peau d’orange appearance.
When to Seek Medical Consultation
Any new or persistent change in the appearance or texture of the breast skin, including dimpling, should prompt an immediate consultation with a healthcare provider. It is impossible to distinguish between a benign and a malignant cause of dimpling by visual inspection alone. Patients should be prepared to describe when the dimpling first appeared, how long it has been present, and whether it is associated with any other symptoms.
Associated symptoms that require reporting include localized warmth, persistent redness, breast tenderness or pain, and any noticeable swelling or thickening of the breast. The initial diagnostic work-up typically includes a clinical breast examination followed by imaging tests, such as a diagnostic mammogram and an ultrasound. Depending on these initial assessments, a physician may then recommend a biopsy to obtain a tissue sample and definitively determine the cause of the skin change.