Breast Dimpling, Puckering, or Stretch Marks: When to Be Concerned

Many women are concerned when they notice changes in their breasts, such as dimpling, puckering, or stretch marks. There are benign conditions that cause these conditions but they may also indicate something more serious. It’s important for women with these symptoms to visit their physician for a more thorough assessment.

Breasts change throughout the normal course of a woman’s life, making it difficult to know which changes are normal and which are concerning. It is important to first discuss what a normal breast looks like.

The composition of a normal breast

A woman’s breast is composed of three different kinds of tissue.

• First is the glandular tissue, which holds the milk sacs and ducts that bring milk to the nipple.
• Next, is a fibrous connective tissue that supports the breast and holds it in place.
• Finally, there is fatty breast tissue that fills in the gaps and gives the breast its fullness and shape.

A dense breast has more glandular and fibrous connective tissue than fat. This makes it more difficult to feel inconsistencies during a physical exam and to see details in a mammogram. Women who take hormones tend to have increased breast density.

The important thing is to regularly check your breasts so you know what is normal for you. Regularly palpate or lightly touch the skin texture and inner breast tissue with your fingertips. Look in a mirror to see the contour of each breast. Knowing your breasts will alert you to new irregularities.

Dimples, puckers, and stretch marks

A woman’s breasts change throughout her lifetime, beginning with breast buds at puberty. This is followed by tender and lumpy breasts during pregnancy and throughout perimenopause and menopause. In the declining years, there are fewer lumps, pain, and discharge. When women find dimples, puckers, and stretch marks, they aren’t sure if these are normal changes or something they should be concerned about.

Breast dimpling

Breast dimpling and orange peel skin are used interchangeably. It is also known by a French term, peau d’orange. The texture of the skin resembles the pitted or dimpled surface of an orange.

There are a several conditions that may cause breast dimpling:

• Injury. The fatty breast tissue can become damaged after an injury to the breast, from surgery, or after radiation therapy. Essentially, the tissue dies and the skin in the area dimples. This benign condition is called fat necrosis, and doesn’t increase your risk of having breast cancer.
• Blocked lymphatic vessels. Infection of the breast tissue or radiation can block the lymphatic vessels in the breast which results in swelling of the tissue and breast dimpling.
• Cancer. The third reason for dimpling is a rare type of breast cancer called inflammatory breast cancer. It causes generalized swelling in the breast tissue and blocks the lymphatic system. Other symptoms of inflammatory breast cancer are redness and the area is tender to touch.

Breast puckers

A pucker is different than a dimpling, and many women won’t notice it unless they first feel a lump beneath the skin. Some breast lumps are attached or tethered to the connective tissue. When the lump is examined and rolled underneath the fingertips, the tether causes an indentation or pucker in the skin.

Pulling or pushing against a lump causing a pucker is called a skin tether (ST) pushing sign. The dimpling or puckering should not be confused with the dimpling of orange peel skin, or puckering from a previous surgery. ST is a classic symptom of breast cancer.

Stretch marks

Roughly 90% of all adults will get some stretch marks throughout their lifetime. Women are especially susceptible to stretch marks on their abdomen and breasts from rapid weight gain during pregnancy. Initially, stretch marks appear as reddish-pink indentations which fade over time into a wide white line.

Stretch marks are always benign. They don’t cause cancer or make you susceptible to cancer. However, new stretch marks can resemble puckers so it is important that they are seen by a physician to ensure a diagnosis.

Since it is impossible to know for sure what you are feeling and seeing, it is important to see a physician to get a correct diagnosis. Some physicians may be more relaxed about skin dimpling, puckering, and stretch marks, and advise you that nothing is wrong. However, you are the sole proprietor of your body, and if you are unhappy with their diagnosis, ask for a second consult or for further testing.

Breast tests

Some breast cancers are evasive and difficult to diagnose. However, medical testing can provide additional information to clarify if your condition is benign or whether you need further treatment. Here are some tests that you can request:

• Mammogram. A mammogram is an x-ray of each breast that is taken from two different angles. The breasts are compressed between two flat plates to make it easier to see the breast tissue. This is uncomfortable but the procedure is quick. It is more difficult to see through dense breast tissue, and some cancers may be missed without the addition of other tests.
• Ductography. A ductography is also an x-ray. However, this time pictures are taken after a contrast liquid has been injected into your ducts, which helps the radiologist to see a better outline of the duct system. This procedure shouldn’t be painful but you can ask your physician for medication to help you to relax.
• Magnetic resonance imaging (MRI). An MRI uses powerful magnet and radio waves to scan the soft tissue of your breast. This test gathers information that can be used in conjunction with a mammogram. An MRI is painless but noisy. You will be given ear plugs to wear throughout the procedure.
• Ultrasound (U/S). An U/S uses sound waves to visualize soft breast tissue. The U/S tech will put a bit of cool-feeling ultrasound gel on your breast. This improves ultrasonic contact and helps the tech to slide the wand across your breast during the procedure.
• Biopsy. Your physician may request a needle or surgical biopsy to obtain a small piece of tissue to send to the lab for a more definitive diagnosis. If this procedure is done in an outpatient clinic, the physician will numb your skin prior to inserting a needle. If it’s done in the operating room, you will be given sedation and anesthesia as per the anaesthetist’s recommendations.

What to do if you notice these signs

It can be nerve-wracking to discover dimpling, puckering and stretch marks on your breasts. Here are some quick tips to follow after detecting a change in your breast tissue:

• Make an appointment with your physician. You need a professional assessment for any dimpling, puckering and stretch marks that you find on your breasts.
• Stay calm. It’s easy to think the worst when you discover skin changes on your breast. Remember, even if it is cancer, statistics show a 90% five-year survival rate, and 80% live for more than ten years.
• Avoid internet searches. You will only increase your anxiety by doom-surfing the internet. Instead, go out for lunch or spend time in nature.
• Find a support network of friends. Even if you’re fairly certain it’s only a stretch mark, reach out to your friends and tell them that you need their support.
• Eat healthy and exercise. Continue eating healthy food and going to the gym. These two activities will keep your mind active and your spirits up.

It’s disturbing to discover an unfamiliar dimple, pucker or stretch mark on your breast. Since it is impossible to know if these symptoms point to something benign or a more serious disease, don't ignore them. Instead, call your physician and make an appointment for a professional assessment and diagnosis.