Breast dimpling
Breast dimpling—the puckering or retraction of skin on the breast—results from abnormal attachment of the skin to underlying tissue. It suggests an inflammatory or malignant mass beneath the skin surface and usually represents a late sign of breast cancer; benign lesions usually don’t produce this effect. Dimpling usually affects women older than age 40, but it also occasionally affects men.
Because breast dimpling occurs over a mass or an induration, the patient usually discovers other signs before becoming aware of the dimpling. A thorough breast examination may reveal dimpling and alert the patient and nurse to a breast problem. (See How to examine your breasts, pages 128 and 129.)
History and physical examination
Obtain a medical, reproductive, and family history, noting factors that increase the patient’s risk of breast cancer. Also obtain a pregnancy history because women who haven’t had a full-term pregnancy before age 30 have a higher risk of developing breast cancer. Has the patient’s mother or sister had breast cancer? Has she herself had a previous malignancy, especially cancer in the other breast? Ask about the patient’s dietary habits because a high-fat diet predisposes women to breast cancer.
Ask the patient if she has noticed any changes in the shape of her breast. Is any area painful or tender, and is the pain cyclic? If she’s breast-feeding, has she recently experienced high fever, chills, malaise, muscle aches, fatigue, or other flulike signs or symptoms? Can she remember sustaining any trauma to the breast?
Carefully inspect the dimpled area. Is it swollen, red, or warm to the touch? Do you see bruises or contusions? Ask the patient to tense her pectoral muscles by pressing her hips with both hands or by raising her hands over her head. Does the puckering increase? Gently pull the skin upward toward the clavicle. Is the dimpling exaggerated?
Observe the breast for nipple retraction. Do both nipples point in the same direction? Is either nipple flattened or inverted? Does the patient report nipple discharge? If so, ask her to describe its color and character. Observe the contour of both breasts. Are they symmetrical?
Examine both breasts with the patient supine, sitting, and then leaning forward. Does the skin move freely over both breasts? If you can palpate a lump, describe its size, location, consistency, mobility, and delineation. What relation does the lump have to the breast dimpling? Gently mold the breast skin around the lump. Is the dimpling exaggerated? Also examine breast and axillary lymph nodes, noting any enlargement.
Medical causes
Breast abscess
Breast dimpling sometimes accompanies a chronic breast abscess. Associated findings include a firm, irregular, nontender lump and signs of nipple retraction, such as deviation, inversion, or flattening. Axillary lymph nodes may be enlarged.
Breast cancer
Breast dimpling is an important but somewhat late sign of breast cancer. A neoplasm that causes dimpling is usually close to the skin and at least 1 cm in diameter. It feels irregularly shaped and fixed to underlying tissue, and it’s usually painless. Other signs of breast cancer include peau d’orange, changes in breast symmetry or size, nipple retraction, and a unilateral, spontaneous, nonmilky nipple discharge that’s serous or bloody. (A bloody nipple discharge in the presence of a lump is a classic sign of breast cancer.) Axillary lymph nodes may be enlarged. Pain may be present but isn’t a reliable symptom of breast cancer. A breast ulcer may appear as a late sign.
Fat necrosis
Breast dimpling due to fat necrosis follows inflammation and trauma to the fatty tissue of the breast (although the patient usually can’t remember such trauma). Tenderness, erythema, bruising, and contusions may occur. Other findings include a firm, irregular, fixed mass and skin retraction signs, such as skin dimpling and nipple retraction. Fat necrosis is difficult to differentiate from breast cancer.
Mastitis
Breast dimpling may signal bacterial mastitis, which usually results from duct obstruction and milk stasis during lactation. Heat, erythema, swelling, induration, pain, and tenderness usually accompany mastitis. Dimpling is more likely to occur with diffuse induration than with a single hard mass. The skin on the breast may feel fixed to underlying tissue. Other possible findings include nipple retraction, nipple cracks, a purulent discharge, and enlarged axillary lymph nodes. Flulike signs and symptoms (such as fever, malaise, fatigue, and aching) are common.
Special considerations
Remember that any breast problem can arouse fears of mutilation, loss of sexuality, and death. Allow the patient to express her feelings.
Pediatric pointers
Because breast cancer, the most likely cause of dimpling, is extremely rare in children, consider trauma as a likely cause. As in adults, breast dimpling may occur in adolescents from fatty tissue necrosis due to trauma.
Patient counseling
Provide a clear explanation of diagnostic tests that may be ordered, such as mammography, thermography, ultrasonography, cytology of nipple discharge, and biopsy. Discuss breast self-examination, and provide follow-up teaching when the patient expresses a readiness to learn. If a breast-feeding patient has mastitis, advise her to pump her breasts to prevent further milk stasis, to discard the milk, and to substitute formula until the breast infection responds adequately to antibiotic therapy.
Book Source Details
- Book Title: Professional Guide to Signs & Symptoms (Fifth Edition)
- Author(s): Springhouse
- Year of Publication: 2006
- Copyright Details: Professional Guide to Signs & Symptoms (Fifth Edition), Copyright © 2006 Lippincott Williams & Wilkins.
Other Book Chapters Related to Breast symptoms
Read excerpts from these other book chapters related to Breast symptoms:
Medical Books Excerpts
- Peau d'orange
- "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
- [ read ]
- Breast ulcer
- "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
- [ read ]
- Nipple Discharge
- "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
- [ read ]
- Breast Mass
- "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
- [ read ]
- Breast pain
- "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
- [ read ]
Copyright Details: Professional Guide to Signs & Symptoms (Fifth Edition), Copyright © 2008 Williams & Wilkins.
More About Causes of Breast symptoms
» Next page: Breast ulcer (Professional Guide to Signs & Symptoms (Fifth Edition))
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