Understanding Dimpling and Lumps - Signs of Breast Cancer

Understanding Dimpling of the Breast

Dimpling of the breast refers to skin changes that cause the breast to take on an uneven or indented appearance. This can occur in one or both breasts. Dimpling is often associated with an underlying breast condition, such as breast cancer, but there are other potential causes as well. Recognizing dimpling and understanding what it might signify is an important part of breast health awareness.

What Does Breast Dimpling Look Like?

Dimpling can occur anywhere on the breast, but is most commonly seen on the lower portion. It may affect a small area or a larger section of skin. Visually, dimpling causes the breast skin to look puckered, wrinkled, or pitted inward rather than being smooth.

Some describe dimpling of the breast as giving the breast an orange peel-like texture or appearance. Mild dimpling may be very subtle, while more advanced cases cause obvious indentations and an uneven breast contour.

What Causes Dimpling of the Breast?

There are a number of possible causes of dimpling of the breast:

• Breast cancer - One of the most concerning potential causes of breast dimpling is the presence of breast cancer. Cancerous breast tumors that are growing and invading breast tissues can cause distortion and dimpling of overlying skin.
• Fat necrosis - Fat necrosis occurs when areas of fatty breast tissue become damaged or die off. This can lead to inflammation and scarring that pulls at breast tissues, resulting in dimpling.
• Breast injury - Past injury to the breast, such as a bruise, blow, or burn, can in some cases cause lingering changes to breast tissues. If scarring develops, it may lead to puckering and dimpling of skin.
• Breast radiation - Radiation therapy for breast cancer can cause damage to skin and underlying connective tissues. This can lead to dimpling in some cases.
• Infection - Infections of the breast, including mastitis or breast abscesses, can lead to inflammation, scarring, and subsequent dimpling.
• Breast implants - Breast implants that develop rippling or folds in the implant surface can cause dimpling of the overlying breast. Leaking or ruptured implants may also lead to dimpling.
• Other benign breast lumps - Many benign breast conditions like cysts or fibroadenomas can cause distortion and dimpling as they grow and compress breast tissues.

Is Dimpling Always a Sign of Breast Cancer?

While dimpling of the breast may be caused by breast cancer, it is important to understand that not all cases of dimpling are cancer. There are many benign breast conditions that can also lead to changes in the breast skin and texture.

However, dimpling is considered an abnormal finding on breast exam and should always be further evaluated by your doctor. It is not possible to determine the cause of breast dimpling based on appearance alone. Diagnostic tests are needed to pinpoint the origin of the breast changes.

When to See a Doctor About Breast Dimpling

You should make an appointment with your doctor any time you notice new or worsening dimpling of one or both breasts. Dimpling is considered a red flag symptom that needs medical assessment. This is true even if you have no family history of breast cancer and the dimpling is not painful.

Breast cancer found early when it is small and still confined to the breast has the best prognosis. Bringing new dimpling to your doctors attention promptly gives the best chance for early diagnosis and successful treatment. Keep in mind that even very subtle changes to breast contour warrant investigation.

Diagnosing the Cause of Breast Dimpling

To determine the underlying cause of breast dimpling, your doctor will begin with a thorough breast exam, including visual inspection and palpation of both breasts and underarms. They will note the location, size, texture and mobility of any detected lumps or thickened areas.

Your medical history will also provide context, such as any previous breast biopsies, radiation or injuries. From there, diagnostic tests that may be ordered include:

• Mammogram - Can often detect masses and calcifications deep in breast tissues that correlate with areas of dimpling.
• Breast ultrasound - Helps differentiate between solid masses versus fluid-filled cysts.
• Breast MRI - Provides highly detailed breast imaging using magnetic fields and computer imaging.
• Biopsy - Removal of samples from breast abnormalities for pathology testing to distinguish between benign and cancerous cells.

These tests allow thorough evaluation of areas of dimpling and abnormal tissue. The results guide appropriate treatment depending on the underlying cause found.

Treating Breast Dimpling

Treatment for dimpling of the breast depends entirely on identifying the specific underlying problem. Some examples of treatment approaches include:

• Breast cancer - Treated first with surgery, often followed by chemotherapy, radiation, hormone therapy or targeted medications.
• Breast infection - Antibiotic medications to clear infection and reduce inflammation.
• Benign breast lump - Removal by surgery for cysts, fibroadenomas and other benign masses.
• Fat necrosis - No treatment needed in most cases. Clears on its own over weeks to months.
• Breast injury - Allows time to heal. Scar massage may help minimize long-term dimpling.

Talk to your doctor about the available and recommended treatment options based on your specific breast health situation.

The Difference Between Breast Lumps and Dimpling

Lumps and dimpling are two different changes that can occur in the breasts. However, they may co-occur in some cases. Recognizing when one or both is present is key for identifying potential breast abnormalities.

Breast Lumps

A breast lump refers to a distinct mass, swelling or node that develops in breast tissue. Lumps may be detected by physical breast exams, self-exams, or breast imaging studies. They may be:

• Located anywhere throughout the breast and underarm area
• Hard, soft, or rubbery
• Mobile and easy to move, or firmly attached
• Smooth, irregular or lobulated
• Tender or not painful

Possible causes range from benign breast changes like cysts to concerning lumps linked to breast cancer. Diagnostic testing like a biopsy is needed to determine if a concerning breast lump is benign or malignant.

Breast Dimpling

Dimpling refers specifically to skin changes causing indentations, puckering, or an orange-peel like texture. This leads to distortion and irregular contour of the breast shape.

Dimpling may occur alone or be associated with an underlying lump. Cancerous tumors that invade the skin and breast tissues can fix the skin to the mass below, creating characteristic dimpling over the distortion.

When Lumps and Dimpling Occur Together

In some cases, dimpling of the breast is directly associated with an underlying palpable lump. Signs to watch for include:

• A hard, immobile lump with skin dimpling directly over the mass.
• Changes to the lump such as growing larger correspond with worsening dimpling of the overlying skin.
• Inflammatory breast cancer, a rare but aggressive type, typically causes thickened breast skin plus scattered dimples referred to as peau dorange.

Dimpling caused by an advancing cancerous lump warrants prompt medical attention. Other concerning combinations include a newly inverted nipple on the same breast, or bloody nipple discharge from the same affected breast.

When Dimpling Occurs Without a Lump

In other cases, breast dimpling forms independently without a definite underlying palpable mass:

• This makes it more challenging to diagnose the cause, and cancer may still be present despite no distinct lump.
• Breast imaging like a mammogram or ultrasound and sampling of breast tissue for biopsy become essential for diagnosis.
• Overlying skin dimpling could represent cancer cells infiltrating and compressing breast tissues below without forming a distinct tumor mass.

Dimpling without a lump should not be assumed benign and still warrants thorough medical evaluation to confirm the breast changes are not linked to hidden cancer.

When Breast Lumps May Be Cause for Concern

Breast lumps are very common and most are non-cancerous. However, a new or suspicious breast lump should never be ignored. Signs a breast lump may need further evaluation include:

• New onset - Lumps that are new or recently noticed need assessment. Benign lumps are often present for months or years without changing.
• Growing lumps - Any lump that seems to be increasing in size over weeks warrants closer investigation.
• Hard, immobile lumps - Lumps that feel firmly attached and dont move freely may be embedded in breast tissue versus just fluid-filled cysts.
• Bloody nipple discharge - Spontaneous nipple discharge that contains blood is associated with papilloma, ectasia and other abnormal breast conditions.
• Nipple inversion - Sudden inward retraction of the nipple may signal an underlying cancerous breast mass.
• Breast pain - While many benign lumps are painless, some cancerous ones may cause breast pain.
• Underarm lumps - Lumps in the underarm lymph nodes, called axillary lymph nodes, raise concern for metastatic breast cancer.

Careful breast self-exams, clinical breast exams, and breast imaging tests like mammograms can help identify breast lumps early, when they are most treatable.

When to See a Doctor About a Breast Lump

You should make an appointment with your doctor promptly if:

• You discover a new, distinct lump in one breast during a self-exam.
• An existing benign breast lump becomes enlarged, hardened, feels different, or is causing new pain.
• Screening mammograms detect changes from your baseline images, like a new mass or grouping of calcifications.
• You develop spontaneous nipple discharge from one breast that is bloody or appears suspicious.

While most breast lumps are non-cancerous, it is crucial to have all new or worsening lumps evaluated rather than making assumptions. Early diagnosis and treatment provides the best outcomes for breast cancer. Stay vigilant about monitoring your breast health.

Diagnosing Breast Lumps

To properly assess an abnormal breast lump, the following diagnostic approaches may be used:

• Physical exam - Location, texture, mobility and appearance of lump.
• Imaging tests - Mammogram, ultrasound, MRI to visualize the lump.
• Biopsy - Removal of cells or fluid from the lump for pathology analysis.
• Surgical biopsy - Excisional biopsy to remove entire smaller lump for diagnosis.

These allow the doctor to definitively categorize the lump as benign (non-cancerous) or malignant (cancerous). Some benign causes of breast lumps include:

• Cysts - Fluid-filled sacs that feel smooth, soft and rubbery.
• Fibroadenomas - Solid, round, rubbery masses that are movable.
• Adenosis - Lobulated, enlarged breast lobules that often fluctuate with the menstrual cycle.
• Fat necrosis - Breast tissue damage causes a firm lump to develop.

Once diagnosed, most cancerous tumors are treated first with lumpectomy or mastectomy surgery. This is often followed by radiation, chemotherapy, hormone therapy or targeted treatments.

When to Worry About Breast Lump Size

One factor that plays a role in determining the significance of a breast lump is its size. In general:

• Small breast lumps under 5 mm are less likely to represent cancer, but still need evaluation.
• Lumps 5-10 mm have a lower, but still significant cancer risk.
• Larger lumps over 10-15 mm have a higher probability of being cancerous.

However, some aggressive breast cancer types can metastasize early and spread to other parts of the body even when the primary tumor in the breast is very small. So ultimately, the size alone does not definitively determine if a lump is cancer.

Warning signs like rapid enlargement, skin dimpling, nipple discharge, or underarm lymph node swelling help identify high-risk lumps. Diagnostic testing like imaging and biopsy examine the internal cells and structure of lump to categorize it.

If breast imaging is abnormal but no distinct lump is felt, this does not mean cancer is ruled out. Mammogram and ultrasound results help guide the need for biopsy in these scenarios.

Large Breast Tumors

Larger breast lumps that are proven to be cancerous may require more invasive surgical treatment. Lumps over 5 cm often need mastectomy. Large cancerous lumps can:

• Be more difficult to eliminate with lumpectomy alone due to size.
• Carry increased risk of recurrence after lumpectomy.
• Involve greater risk of cancer cells spreading to lymph nodes.
• Limit breast reconstructive options after mastectomy.

However, breast conservation surgery is sometimes still possible even for larger non-inflammatory breast cancers up to 5 cm. The choice of lumpectomy versus mastectomy depends on many unique factors in each breast cancer case.

Small Breast Lumps

Smaller breast lumps under 5 mm have a lower chance of being cancerous. However, breast cancers found when they are small often have better prognosis. Signs to remain vigilant for with smaller lumps include:

• New onset or growth detected during self-exams.
• Characteristics on imaging like irregular shape or spiculated margins.
• Abnormal cells on biopsy, even if the lump is tiny.
• Changes to the lump over time, like growing larger.

Careful monitoring, imaging and biopsy help determine when even tiny breast lumps require treatment. Catching cancer early provides more treatment options and improved survival.

Tips for Checking Your Breasts for Lumps

All women should become familiar with their baseline breast composition and remain vigilant for changes. Self-exams help detect breast lumps early when they are most treatable. Tips include:

• Get to know the look and feel of your breasts when they are normal.
• Inspect breasts visually in the mirror periodically for skin changes, redness or dimpling.
• Feel your breasts gently for lumps monthly right after your period ends.
• Use a circular pattern starting at the outside, moving toward the nipple.
• Pay close attention to underarm lymph node areas for lumps and swelling.
• Repeat self-exams in the shower using soapy hands to help feel lumps.
• Report any new lumps promptly to your doctor for evaluation.

Clinical breast exams by your doctor during regular check-ups plus annual mammograms after age 40 help provide comprehensive breast monitoring. Any abnormal breast findings warrant prompt medical follow up.

When to Worry About Breast Lump Mobility

Whether a breast lump feels fixed or is able to be moved can provide insight when evaluating potential breast abnormalities. In general:

• Movable lumps suggest a benign fluid-filled cyst.
• Lumps fixed to deeper tissues raise concern for a cancerous tumor.

However, there are exceptions. Some key considerations about breast lump mobility include:

Mobile Breast Lumps

Lumps that feel

Disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult with a healthcare professional before starting any new treatment regimen.