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What is meant by 'puckering and/or dimpling' of the skin? I have just done a breast self-exam and when I sit down, put my
arms above my head and stretch my arms upward plus when I lean forward, I've noticed what I believe to be puckering and
dimpling of my skin on both breasts stretching from just above the nipple to right at the top of the breast tissue. This is
much more noticeable on my left breast. But it is more noticeable on my right breast when I do the same thing standing up.
I've had this for nearly four years since I first started breastfeeding my eldest son, and I have been breastfeeding for a
total of almost 12 months since my second son was born. This puckering and dimpling looks like scarring and also looks like
loose skin being pulled upwards. In fact it's even more noticeable when I physically pull the skin upward and it's during
that time when the skin wrinkles like an elderly person's skin. Is this caused by just sagging of my breast tissue and skin
either due to my age (I'll be 30 in September), the breast skin being stretched due to swelling of both breasts caused by the
filling of breast milk, because I've gained and lost a few pounds in weight, or is it something more sinister like breast
cancer. Now, although I haven't found any unusual breast lumps, I'm worried sick because I only recently read that puckering
and dimpling of the breast skin is a clear sign of breast cancer. Do I have any reason to worry?
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Answer by Dr Dennis S, MD on Mon 03, Mar 2008 11:44am:
Hi.
<SPAN style="BACKGROUND-COLOR: #ffff00">I commend you for being observant with the changes in your body and for doing breast self-examination.</SPAN>
The American Cancer Society recommends clinical breast examination by a health professional every 3 years and monthly breast self-examination for women aged 20-39 years. Annual mammography with clinical breast examination is recommended is recommended for women aged 40 and above, as well as monthly breast self-examination.
<bold> The breast is composed of mammary glands which become engorged during pregnancy.</bold> This engorgement can be mistaken as a breast mass. Surrounding these glands are considerable amounts of fatty tissue. The breast also has suspensory ligaments called Cooper’s ligaments. These are fibrous bands that infiltrate the breast tissue vertically.
Shortening of the suspensory ligaments of the breast can cause dimpling. This can occur in malignancy as well as during or after an inflammatory process in the breast. <FONT style="BACKGROUND-COLOR: yellow"> The suspensory ligaments may become prominent when there is small amount of fatty tissue (during weight loss and old age) in the breast resulting in dimpling of the overlying skin.</FONT>
It would be helpful if you can provide more information on you and your condition. Do you have breast lumps or tenderness? Any change in the character of your nipple? Do you have constitutional symptoms like weight loss and fatigue? Do you have a family history of breast cancer?
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Follow up:
Clarification by gaylestephen on Mon 03, Mar 2008 01:20pm:
I'm physically well in myself, but there is some very slight breast tenderness probably because I've
cut right down on the breastfeeding & starting to give my son bottles more often particularly throughout
the day because straight after giving a breastfeed during the night, the tenderness subsides. Other than
that, there has been no other changes. I've not seen any nipple changes nor have I found any unusual
lumps. The weight loss has not been sudden and dramatic, but is in fact due to cutting down on my meal
portions as I am slightly overweight. I am also not regularly fatigued. I have no particular family history
of breast cancer but I have lost my dad and both my grandads to cancer. In fact one of my grandads died of
prostate cancer and I've read rumours that the faulty gene for prostate cancer can be passed down to a
female relative putting her chances of developing breast cancer very high. Is this really true? Also I'm
waiting for the results of a Pap smear and I am particularly on edge as that was my first one. I had it later
than you would've liked because when I recieved my first invitations, I was not sexually active, but
during the time I gave birth to my first son, the British NHS were in the process of changing the minimum age
for having Pap smears from 20 yrs to 25 yrs and I was expecting an invitation by the time I reached 25 yrs but
didn,t get one. I've also read that CIN at all levels had no symptoms. Is that true because I'm
now really scared that I could be getting cervical cancer and not realizing this. Are my chances of getting
CIN really high. Please help.
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Comments:
Comment by Dr Dennis S, MD on Wed 05, Mar 2008 05:05pm:
Hi.
Thanks for the clarifications.
Engorgement of the mammary glands because of milk production during lactation can cause some breast
tenderness. As I’ve said, the engorged mammary gland can be mistaken for a breast mass during palpation. An
ultrasound of the breast can help determine if there is a cystic mass or a solid mass in the breast. The
decision to whether to undergo breast biopsy of the suspicious mass depends on the characteristic ultrasound
finding.
As for the relationship of prostate cancer and breast cancer, it is not known if such a relationship exists.
Cancer, in general, is caused by genetic alterations like point mutations, gene deletions and amplifications.
Inactivation of tumor suppressor genes is also common in cancers.
Cervical Intraepithelial Neoplasia (CIN) is a preinvasive condition and is based on cellular immaturity,
nuclear abnormalities, cellular disorganization, and increased mitotic activity as interpreted by the
pathologist. This condition is designated as CIN 1 for mitoses and immature cells involving the lower third
of the epithelium, CIN 2 for the middle third, and CIN 3 for the lower third. There is a positive
relationship between human papilloma virus (HPV), CIN, and invasive carcinomas of the cervix. The American
Cancer Society recommends screening for all women who are, or have been, sexually active or who have reached
age 21 years. Preinvasive disease is not associated by symptoms and is usually detected on routine cervical
cytologic screening. After a diagnosis of CIN, superficial ablative therapy can be given involving
cryosurgery or laser therapy.
Comment by admin on Tue 06, May 2008 10:39pm:
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