Breast dimpling is an indentation, puckering, or visible depression on the skin of the breast. This change can range from subtle to pronounced. Its presence often prompts concern due to potential implications for breast health.
How Breast Dimpling Appears
Breast dimpling often appears as skin with a rough texture, similar to an orange peel, known as “peau d’orange.” This can range from small, localized indentations to a larger, uneven texture across a breast section. Dimpling may become more noticeable when the arm is raised or the breast is moved, as these actions accentuate pulling on underlying tissues. It can appear anywhere on the breast, including the nipple or areola.
Underlying Reasons for Breast Dimpling
Breast dimpling typically results from changes or tension within the underlying breast tissue. This often involves the Cooper’s ligaments, which are fibrous tissues that provide support to the breast. When these ligaments or surrounding tissues are affected by various conditions, they can pull on the skin, causing the characteristic dimpled appearance.
Several non-cancerous conditions can lead to breast dimpling. Fat necrosis, damage to fatty breast tissue often due to injury, surgery, or bruising, can result in a firm lump and dimpling of the overlying skin. Scar tissue from previous biopsies, surgeries, or infections may also cause skin retraction and dimpling. Benign lumps or cysts can sometimes pull on the skin, contributing to dimpling. Inflammation or infection, such as mastitis, can cause swelling and changes in skin texture, including a peau d’orange appearance. Natural aging processes, involving changes in skin elasticity and breast tissue, can also lead to minor dimpling.
Certain types of breast cancer can also cause dimpling. A tumor growing within the breast can pull on the Cooper’s ligaments, causing skin retraction and dimpling. Inflammatory breast cancer (IBC), a less common but aggressive form, is associated with widespread skin changes, including dimpling resembling an orange peel. This occurs when cancer cells block lymphatic vessels in the breast skin, leading to fluid buildup, swelling, and a pitted appearance. Unlike other breast cancers, IBC may not present with a distinct lump but rapidly causes symptoms like warmth, redness, and swelling alongside dimpling.
When to Consult a Healthcare Professional
Any new, persistent, or unexplained breast dimpling warrants evaluation by a healthcare professional. Dimpling can be a sign of a serious underlying condition. Specific scenarios or accompanying symptoms should prompt immediate consultation. These include new onset of dimpling that does not go away, or dimpling accompanied by a lump, pain, redness, warmth, or swelling of the breast. Changes in nipple appearance, such as inversion or discharge, or alterations in breast size or shape, also necessitate a medical assessment.
What to Expect During a Medical Evaluation
During a medical evaluation for breast dimpling, a healthcare professional typically conducts a thorough physical examination. This involves visually inspecting the breast for dimpling and other skin changes, often with the patient in different positions, such as raising their arms or placing hands on hips, to accentuate any indentations. The doctor will also manually examine the breast and armpit area to feel for any lumps, areas of tenderness, or thickened tissue.
Following the physical exam, imaging tests visualize the breast tissue. A mammogram, an X-ray, is frequently the initial step. An ultrasound, using sound waves, can distinguish between solid masses and fluid-filled cysts. MRI may be used for more detailed imaging, especially if initial tests are inconclusive. If imaging reveals a suspicious area, a biopsy obtains a tissue sample for laboratory analysis to determine if cancer cells or other specific conditions are present.