Breast dimpling is a noticeable indentation or depression in the skin, often near the nipple or areola. This change in surface texture signals an underlying alteration in the breast tissue. Recognizing this symptom is important for seeking medical guidance.
The Visual Characteristics of Nipple Dimpling
The most common visual characteristic of breast dimpling is a texture known as peau d’orange, or “orange peel skin.” This appearance is marked by numerous tiny, shallow indentations that cause the skin to look pitted, rough, and uneven. The affected skin may also appear thick or swollen.
The depth of the depression varies, ranging from subtle puckering to a distinct, fixed dent. The dimple may be isolated or cover a larger region, indicating a loss of normal skin pliability.
The indentation may not always be visible when the body is at rest. Dimpling often becomes more pronounced when the breast tissue is manipulated or muscles are tensed. Raising the arms overhead or pressing the hands onto the hips can intensify the underlying pull, making a hidden dimple apparent.
Dimpling can also cause the nipple to flatten or invert, pulling it inward. Unlike temporary changes, this retraction is often fixed. A fixed dimple is significant, especially if the skin cannot be easily pinched away from the underlying tissue.
How Dimpling Develops
The mechanism behind breast dimpling is rooted in the internal support structure. Breast tissue is anchored to the chest wall and overlying skin by Cooper’s ligaments. These ligaments run through the breast tissue and connect to the dermis, maintaining the breast’s shape.
Dimpling occurs when a pathological process, such as an abnormal mass or scar tissue, interferes with these ligaments. An internal mass or fibrotic change can shorten or place tension on Cooper’s ligaments, pulling them taut. Since the ligaments are tethered to the skin, this inward pull causes the overlying skin to retract and form a concave depression.
A different mechanism is lymphatic obstruction, which leads to the peau d’orange texture. Cancer cells or severe inflammation can block lymph vessels, preventing normal fluid drainage. This causes the skin to become edematous (swollen and thickened). The anchored hair follicles then create the pitted appearance as the surrounding skin swells.
Underlying Medical Causes
Dimpling can be caused by a variety of medical conditions, ranging from benign changes to aggressive cancers. Inflammatory Breast Cancer (IBC) is a rare but rapidly progressing malignancy that often presents without a distinct lump. IBC frequently causes the skin to become red, warm, and swollen, with pronounced peau d’orange texture resulting from lymphatic blockage.
More common types of breast cancer, such as Invasive Ductal Carcinoma, can also cause dimpling. A tumor growing within the breast can directly invade and shorten Cooper’s ligaments, creating localized skin tethering. The dimpling may be the first or only visible sign, especially when the tumor is not easily palpable.
Benign Causes
Several benign conditions can also cause dimpling. Fat necrosis occurs when fatty tissue dies (often after trauma or surgery), causing localized scarring. The scar tissue can retract and pull the overlying skin inward, creating a dimple that mimics a tumor. Infections like mastitis can cause temporary thickening or a dimpled appearance, often accompanied by pain and warmth. Surgical changes or the presence of a benign mass, such as a large cyst, can also create internal tension leading to skin retraction.
Necessary Steps If You Notice Dimpling
If a new or persistent dimple or change in breast skin texture is observed, schedule an appointment with a healthcare provider immediately. Determining the cause requires a professional medical assessment to rule out serious underlying conditions, regardless of whether the dimple is accompanied by other symptoms like pain, redness, or a lump.
The diagnostic process begins with a clinical breast examination, where the physician assesses the texture and contour. The doctor will likely order medical imaging, including a diagnostic mammogram and an ultrasound. These tools visualize deeper tissues to determine if a mass, scar tissue, or fluid accumulation is present.
Depending on the imaging findings, the next step may involve a biopsy, the only definitive way to diagnose or exclude cancer. A small sample of the suspicious tissue is removed and examined under a microscope. Seeking professional guidance ensures that any necessary treatment can begin promptly.