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ULY CLINIC
ULY CLINIC
Breast dimpling
Definition
Breast dimpling is the retraction or puckering of the skin on the breast, typically indicating underlying attachment of skin to abnormal tissue such as inflammatory or malignant masses. It is a late sign of breast cancer and rarely caused by benign lesions.
Key Clinical Features
Common in women over 40, but can also affect men.
Usually noticed after other signs (lump, pain) or found on clinical breast exam.
Appears over areas of induration or mass.
History Taking
Ask about:
Age, reproductive, and family history (BRCA status, cancer history).
Pregnancy history (nulliparity before age 30 = higher risk).
Previous malignancies, especially contralateral breast cancer.
Diet (high-fat diets are a risk).
Recent trauma or signs of infection during breastfeeding.
Breast changes: shape, tenderness, cyclic pain, or nipple discharge (color, type).
Physical Examination
Inspect for:
Redness, swelling, warmth.
Contour changes and asymmetry.
Nipple retraction, deviation, flattening, inversion.
Exaggeration of dimpling with pectoralis tension (hands on hips or raised arms).
Palpate:
Lumps: note size, consistency, mobility, and relation to dimpling.
Skin mobility over the lump.
Axillary lymph nodes for enlargement.
Compare both breasts in various positions: lying down, sitting, leaning forward.
Possible Causes
Cause | Key Features |
Breast Cancer | Irregular, fixed, painless lump. Late signs: peau d’orange, nipple retraction, bloody discharge, axillary node enlargement. |
Breast Abscess | Chronic, firm, irregular lump with nipple retraction and enlarged lymph nodes. Usually nontender. |
Fat Necrosis | Post-trauma. Hard, tender lump with bruising and skin changes. Can mimic cancer. |
Mastitis | Often in lactating women. Diffuse swelling, warmth, pain, nipple cracks, fever, and systemic signs. Dimpling occurs with diffuse induration. |
Special Considerations
Emotional support is crucial. Breast issues raise fears about body image and mortality.
Teach breast self-exam, clinical follow-ups, and mammography importance.
If lactating, advise milk pumping, discarding infected milk, and formula use during infection.
Pediatric Pointers
Breast cancer is rare in children.
Most likely cause is trauma-related fat necrosis in adolescents.
References
Jemal A, et al. Global cancer statistics. CA Cancer J Clin. 2011;61(2):69–90.
Moyer VA. BRCA-related cancer screening. Ann Intern Med. 2013;160:271–281.