It is well known that a breast lump needs to be investigated, but there is another less common finding that needs evaluation, too. This finding is skin retraction. In the large series of patients collected by Haagensen, one of the early leaders in the study of breast disease, 3% of women presented to his breast clinic with skin retraction.
Skin retraction can be anything from a dimple to shrinkage of the entire breast. It occurs because of abnormal traction on the Cooper's ligaments inside the breast. When a process causes scaring inside the breast and "pulls" on these fascial septa retraction or dimpling can appear in the skin. If the process involves the entire breast then the the skin appears distorted and even fixed to the underlying pectoralis muscle.
The process that causes dimpling can be both benign and malignant. Inflammation like an infection or fat necrosis after breast trauma can cause skin retraction. Cancer can also cause skin retraction. The finding can be subtle or only seen in certain positions. This is why the first part of the clinical breast examination is inspection and with the arms in three different positions, like directing the airplane into its parking place at the airport some have said. Dimpling is often difficult for the woman herself to see because of the vertical orientation of her eyes "above" her breasts and more often detected by the doctor who has a more horizontal orientation during inspection.
Dimpling may be an early symptom of breast cancer that can lead to early and breast-saving treatment.
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