Breast Dimple but negative mammo and US
I (34F) recently had a breast dimple investigated with a diagnostic 3D mammogram and limited ultrasound. Both reported no imaging abnormalities. However, I did receive notice that I have extremely dense breasts and am at high risk for breast cancer due to family history (27% on Tyrer-Cuzick).
My concern is that the breast specialist did not have a benign differential diagnosis for the breast dimple. It showed up in early Nov and sometimes also has a large area of discoloration around it. When I asked he said it was just anatomy.
I've heard of breast cancers that could cause dimples (invasive lobular breast cancer and inflammatory breast cancer) being harder to detect on imaging tools. Could it be possible that both the mammogram and ultrasound missed something? If not, what are some benign causes of breast dimples that wouldn't show on images?
Just for added information, I do not feel a lump. Just have the dimple and occasional skin color changes around it.
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Dimple prompted me to thoroughly check my breast ended up feeling the lump. Mammogram and a biopsy later confirmed breast cancer. This past Wednesday had annual mammogram, 3 years cancer free Thank God
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So glad to hear this! And thank you for sharing your story.
Mine doesn’t have a lump that I can feel. Skin is a little thicker and changes shades grayish purple. Sometimes the skin around the dimple (about 2.5 inches in diameter) is just a few shades off my normal color with a darker outline around the area and other times the outlined area is filled in with a weird grayish purple shadow. There doesn’t seem to be a pattern to it. The dimple itself is only about an inch and is a little off center in the discolored area. There seems to be a second dimple forming right under the first one. The whole area is a little tender to the touch.
I just wish the doctor was able to give a definitive benign cause for the dimple and the skin discoloration. All they were able to say was that nothing is showing up on the scans and I have dense breasts and high risk. But maybe I need to find comfort in no news is good news.
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Hi Stboo67,
I am sorry to see you have concerns without answers. The dimple is concerning. You are correct that the discoloration or appearance of bruising is cause for concern. Keep monitoring monthly for any other changes or additional dimples next to the one you found. If you find other changes contact your doctor to see about additional tests. Hopefully, the dimple is a simple change. It isn't likely that you will get a biopsy unless a mass is found on mammogram or ultrasound. Crazy as that sounds. The team needs to find the " what and where" to biopsy. Unfortunately, with dense breasts it can take time for anything to be found on a mammogram or ultrasound to biopsy. Again, keep monitoring. AND stay off Doctor Google. You will get much better answers here from people who have had similar experiences. Post any questions or concerns you have while you continue to monitor.
Wishing you warm thoughts and sending hugs your way.
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Thank you. I appreciate the reassurance. And the positive thoughts.
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Is there a possibility you could have a breast MRI?
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When I asked about it, the breast specialist said he was more worried about a false positive because an MRI is more likely to lead to an unnecessary biopsy. My mom and boyfriend both told me to insist on an MRI but once the breast specialist said no, I felt foolish pushing for it, so I let it go. Afterwards, I wish I had asked why he was more worried there would be a false positive on imaging I haven't had yet that than he was about an undiagnosed concerning symptom. Especially since an MRI could rule out the potential of a false negative in my current imaging.
I know that this should be good and comforting news right now. After all, I have clear scans,I should be celebrating right now. However, it still feels unresolved and I feel ashamed that I am still worrying about it. It just feels like only things I learned through this process are that I am high risk, have extremely dense breasts that can make some imaging protocols less sensitive, and have these weird symptoms that are probably fine, but they don't know why I have them.
I also learned that I'm too young for annual screening so they won't follow up with additional images for a few years. I do have both my primary care doctor and gynecologist do a physical breast exam each year (so that's twice a year) and monthly self checks and will continue with that as I wait until I am old enough for annual screenings.
After a scare like this, what are some tips to help accept that everything is alright, even when you don't have all the answers of what's going on? I know avoiding the Google is definitely on the strategy list. And reaching out on this post, I was hoping to find other women to say, "that happened to me too and it was just fine" or "ask you doctor if it could be this, that's what it turned out to be when it happened to me." But what are some other reassuring strategies?
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So this is not a reassuring strategy, but I want to say that I had negative US scans, negative mammograms (3d). Despite that, I actually had a 6x6x4 tumour (like a spiders web, not a solid mass) of ILC unseen on imaging, non palpable. My only symptom was a change in my breast (nipple flattened) and both my breasts had gotten larger (which was due to the HRT that I was taking). So, maybe a dimple is just a dimple but.... so what if your MRI is a false positive? You might have to endure a biopsy, which is no fun, but it's pretty minor, compared to actually having undiagnosed breast cancer.
I don't know your age and I am really really sorry if I am sounding like some kind of doomsday person but I lost 2 friends to breast cancer in their 30s. I don't think pushing for an MRI is overkill. At the very least make sure that you are being closely monitored, I definitely don't think you should wait 'years' for another scan.
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Hi Trinigirl,
I appreciate your honesty. I am uncomfortable with not having answers and have been wondering whether or not a second opinion is appropriate.
If you don’t mind me asking, when you were in the diagnostic phase, what did your journey look like when you went from the negative scans to finding the ILC? What made you and your team keep investigating the symptoms
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I was 50 at diagnosis. I pushed for a biopsy. The breast specialist saw "fibroadenoma" in the scan but this was unchanged from scans I had been having for previous 5 years when I first started having mammograms. Due to my dense breasts I was always sent for US scans as well as mammograms so the fibroadenoma was nothing new. I had recently started taking HRT which I immediately stopped taking. The breast specialist thought the changes might have been hormonal due to the HRT, and certainly my breasts had gone up an entire size since I started it. I wasn't actually concerned about the increase in size because the same thing had happened in my 20s when I started on birth control pill. It was the flattened nipple that scared me.
When I asked him why my nipple had flattened, he had no good answer, so I asked for a biopsy. He agreed to biopsy the fibroid area (I know it isn't called a fibroid but I can't remember the correct term) because as he put it "well your breast has changed, so it can't hurt to check". BTW he was a private breast specialist/surgeon, who I had gone to see the minute I saw the flat nipple and I paid for the biopsy myself (not insurance company). I was (am) very healthy, very slim and absolutely no family history of any kind of cancer, zero red flags. He was pretty sure it wasn't cancer until it was. And then we thought it was caught early until the mastectomy, at which point I was stage 3. We were all in total shock. Not least of all me.
Has he given any reasonable explanation for the dimple? He is a breast specialist right? Again, this is just my story, and highly unlikely for you, but I can't see how a second opinion can hurt. At the very least if only to put your mind to rest.
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He was a breast specialist. After I got my results from the imaging center, it suggested I talk to a breast specialist since I am high risk and I fall in the extremely dense breasts range. The report said I could benefit from an MRI based on my doctor's suggestion. My primary care doctor said that a breast specialist needs to write the order for an MRI. I asked my primary care doctor for a referral and went to a breast specialist she suggested.
The appointment with him was quick. He did another physical exam and just repeated what the imaging report said, no abnormalities found. I asked him if there was something on the scans that showed what could cause the dimple and he said that nothing showed up. Then I asked that since nothing showed up and I have extremely dense breasts, what about an MRI. That's when he explained about the false positive. He again reiterated that my scans were clear. It felt like he was either starting or ending every sentence with, “since nothing is on your scans."
Once he said no to the MRI, I moved onto questions about following-up and early screening. He kept saying he didn't want to push it, again because my scans are clear and there is little benefit for screening in women my age. He eventually said that if I wanted I could start 10 years before the age of youngest relative diagnosed with breast cancer, but he didn't think it was necessary.
The experience left me feeling unsettled. I go back and forth wishing I pushed for more answers and wondering if I am just making something out of nothing. Given the information the doctor has, he is right; statistically, it would be the tiniest chance possible that the scans missed something. Any additional testing probably does have more of a chance of providing a false positive than it does a false negative.However, it's not 100% certain.
I do have my annual women's wellness appointment coming up this week at my gynecologist's office. She usually does a physical breast exam in addition to the pelvic exam. I think I will bring my concerns to her and see what she thinks about seeking another breast specialist for a second opinion. She's part of a different network and she might be able to have a different recommendation for a breast specialist to talk through my lingering concerns.
Thank you for telling me your story and helping me build some more confidence in asking questions about this.
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Stoob67,
I had annual mammograms for three years before my dx and yearly checks ups with my GYN regularly. I, too, have extremely dense breasts. I found the lump by accident less than a year from an "all clear" mammogram. Afterward, I noticed the discoloration in my breast and the dimple. From the time of findings on June 23rd to surgery on August 18th, the dimple went from one to three. I didn't know MRIs were an option until after my dx. I had one July 14th after my dx which did show the mass. I wondered for quite some time if I had known to ask for an MRI before my dx because I have extremely dense breasts if the cancer would have been found much earlier. I now get to do the MRI annually as a regular check up. I don't think requesting an MRI is overkill. If nothing shows up, you will get peace of mind. Still, continue to monitor for any changes.
I went to MO in September '21 for a lump in the other breast, who sent me in for an US. Nothing showed up at the time. I continue to monitor monthly for changes, and I return on Monday to get it checked again. The left breast now has a dimple, and I have swollen nodes on the left side. Unfortunately, unless a mass is found during an exam, it is a "wait and see" until something shows up or it is concluded it is a breast change that is non-cancerous.
If you have extremely dense breasts, challenge your doctors with questions and tests until you get a resolution. If you are not satisfied and they continue to tell you nothing shows up, continue to monitor your breasts monthly for any changes. You must monitor and follow up with your doctors if you do find additional changes. And it is totally okay to challenge and question doctors. :-)
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Hi Wondering 44,
Thank you for sharing your story. It helps build confidence to continue to monitor body and continue asking questions.
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I just wanted to offer another vote of support for requesting an MRI. If you have family history, very dense breasts, and have experienced a recent change, I think it’s perfectly reasonable to get a baseline MRI, which hopefully brings peace of mind.
I have a strong family history and very dense breasts and was told I should get a baseline MRI at 38, 4 years before my actual diagnosis. Unfortunately I didn’t. If I had, I might have been able to catch mine before it had a chance to spread to a lymph node. The 1.8cm breast cancer that I found myself, never showed up on mammo, (but did show up on US and MRI).
Hopefully the MRI doesn’t show anything and it will be incredibly reassuring. And like trinigirl said, a false positive, although stressful, is a lot better than undiagnosed BC.
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stboo607:
I completely agree with the others. Just giving my two cents. I'm no expert. But I've been through breast cancer dx. I had extremely dense breast tissue at my dx in 2017. https://www.areyoudense.org/ read the stories on this site. There are tons of women who caught their cancer late stage. Not saying this is cancer for you. But I'd rather have a mri and biopsy with false positive. I'd want to know too what that was for sure too. Too many things you mention would be red flags for me. And your dr isn't giving you solid answers I don't think. In this day and age we have to push for what we need diagnostic wise. Unfortunately
Also I'd get a second opinion. Hopefully you live somewhere where you have more than one breast dr. We are all here for support.
Oh also one more thing I thought I’d say. There are people here who’s cancer didn’t show up on mammo. I’m one of those. Also there are people who’s cancer was missed on ultrasound. And I believe mri too. But mri usually catches stuff. Not every diagnostic works to catch all cancer. That’s why having a mri is important I think. Just my two cents.
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Thank you Jenny Jo & Jons Girl,
Thank you both for listening to my story and helping me make the decision to go for a second opinion. I have my annual gynecologist appointment this week and I am going to get a referral to get a second opinion from a breast specialist. With my insurance, the order for an MRI or early screening needs to come from a breast specialist. I'm going to be very clear with what I am looking for in a second opinion and hopefully she can suggest some breast specialists in the area that I can look into. The original breast specialist was in my primary care doctor's medical group and was their only one. My gynecologist is from a different medical group and hopefully she knows other specialists I can talk to. I will keep you posted.
Thank you all so much for the support. This thread has been the most helpful support I've had. It's helped me figure out how to better articulate my concerns and identify the questions I need answers to for my mental and physical health.
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Hi stboo607, I agree with everyone else - request a MRI. Mammogram and ultrasound miss things, especially for ILC.
My mom was recently diagnosed. The tumor is very large and late stage now - the oncologist said it's probably been there for some years. She had annual diagnostic mammogram and ultrasound (dense breast tissues) every year, which completely missed it. 2.5 years ago she started to feel an area of hardness/firmness on that side of breast, went to see the gyn and did a targeted area mammo and ultrasound, which still showed nothing. The gyn said it's probably post-operational tissue change from surgical excisional biopsy of a benign mass before. Looking back now, that did not make any sense because that surgery was more than 30 years ago. How could you have "post-operational" change from something 30 years ago? But since the mammo and ultrasound report said "benign", we took that explanation and were dismissed just like that.
She continued to feel that firmness area in the next 2.5 years but the annual mammo and ultrasounds continuously said "benign" and even BIRADS1 "negative". Then 2 months ago breast shape and skin color/texture appeared to have changed. Only at this point the ultrasound finally saw something abnormal - BIRADS5. After the biopsy diagnosis, a breast MRI was finally ordered, which revealed the tumor size is actually 6 times of the size shown on the ultrasound. During all this time we never thought about seeing a breast specialist/surgeon or requesting an MRI. We believed it was benign based on the ultrasounds. We missed the chance to catch it at an earlier stage. I regret it everyday and will do for the rest of my life.
Don't let the doctor dismiss you like that. Get a second opinion and an MRI, even just for peace of mind.
I'm looking into getting an MRI myself now, since my strong family history of breast cancer and ovarian cancer puts me into the high risk group of 25%+ lifetime risk now. And I currently have a lump under semi-annual ultrasound monitoring for over a year...I wasn't concerned but now I don't trust ultrasound anymore.
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Hi Ivla,
Thank you so much for sharing your family’s story. I am keeping your mom in my thoughts. Your story is definitely helping me push to continue to investigate my breast changes.
Please keep us posted on your journey. If you are able to get an MRI, I’d love to hear tips on how to approach the conversation and not back down.
I will also keep this thread posted. Hopefully, we can generate tips for women who are also still concerned after images that still leave us questioning. Doctor’s offices have these weird power dynamics and aren’t always spaces that feel safe to speak up. e could all use help navigating it.
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Stboo607, Sounds like you have gotten what you need from this thread. I am happy that you have an appointment with your GYN. I really hope that you get somewhere with her. Please don't stop pushing until you get answers. As with anything, the sooner the dx (if there is one) the better the outcome. You need to know for sure. I really don't have anything to add to what everyone else has said. I would just reiterate that your concerns are valid and we all need to take charge of our health and ask for what we need and deserve.
I will be thinking of you. Do keep us supdated. Blessings and hugs.
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Thank you Zebra co! I appreciate the blessings. I will keep the thread posted
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UPDATE: I was able to talk to my gyno today. She agreed that I was right in asking for a second opinion. She was able to get me a referral for a different breast specialist that other patients have had positive experiences with. I have an appointment for Feb 2. Thank you to everyone for the support. I feel better knowing there will be a second set of eyes on everything.
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Kick, scream , bite whatever you have to do to get attention, I presented exactly as you and was told by several Dr, Oh its nothing . I demanded to see surgeon who agreed that it was something . Stage 2, 2.69 cm IDC that was totally missed in the 3 previous mama that I had . Surgeon said that he could see it in previous mama . It was missed by tech because I have dense breast
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Hi HoneyBeaw,
Thank you so much for sharing your story and for the support. I am bringing my previous scans with me. Have them in a disc already. I've never actually seen the scans. I've only seen the report. I might ask him to show me the scans and have him talk me through what he sees or doesn't see. Regardless, I'm going to make sure he reviews them and helps me come to a more conclusive answer to my skin changes than what I got from the last doctor. I've also started taking pictures of it every few days. It's hard to see changes over time in the pictures, but I can definitely see the dimples. So if he says he can't see them on the day of, I've got picture evidence. This thread has really helped me think through ways to push for answers.
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Hi, Stboo607. I just saw that your original post mentioned 27% risk. This should justify an annual MRI. See below: https://www.cancer.org/cancer/breast-cancer/screen... I showed that page to my gyn and he agreed on an MRI.
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Hi Ivla,
Thank you for the resource. When I asked the previous breast specialist about early screening and an MRI because of my high risk, he said that it would be 10 years before the youngest relative (which is my cousin and she was 48 at diagnosis). So he told me that I would start that at 38, which is still 4 years away for me.
I am definitely going to bring this to the breast specialist that I am getting the second opinion from. Even if he is unable to give me an answer for my skin symptoms now, hopefully we can come up with a plan to continue to follow up on it through early screening schedule that includes regular mammograms andMRIs.
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I hope all goes well at your appt stboo. When is your appointment? If you told us I forgot. have a good weekend
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Hi Jons_girl,
My appointment is Feb 2nd. I will definitely update the thread afterwards
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ok I hope all goes well
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I wanted to update this thread. First off, I would like to thank everyone on this post for all the support and guidance. You really did help me make the decision to get clarification through a second opinion.
I saw a breast specialist today. They spent a lot more time with me talking through my symptoms and risks. They also redid the ultrasound and suggested I do genetic testing to more accurately asses my risk and help come up with a customized screening plan.
As for the breast dumpling, they did another ultrasound and will be comparing to the previous images. At the moment, there is nothing for concern under the skin showing on the ultrasound, which is good news. They explained future changes I should be looking for to help monitor the symptoms between now and my next follow up appointment. They suspect the sudden skin changes could be due to weight changes. They suggested I more closely monitor my weight changes and compare that to potential changes in my skin. This was the first time I learned that weight changes could impact the skin around your breasts. We do have a follow up in 6 months for another ultrasound to see if anything changes under the skin as well, just incase.
I am feeling much more confident after this appointment than I did during my last. It does feel like this specialist is doing more to try to minimize the chance that something could have been missed. They gave clearer tips on how to monitor the skin changes, took another look under the skin, and made plans for a follow up. Additionally, they are helping me more accurately assess my risk and come up with a screening plan based on that. I should know the results from the genetics test in a few weeks and we will move forward with a screening plan from there.
Again, I would like to thank everyone for sharing their stories, giving advice, and encouraging me to seek someone who will answer my questions and be open to hearing my concerns.
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Hi Stboo,
I consider that wonderful news. I'm glad you were given a thorough exam and a detailed plan for future monitoring. Thank you for coming back to update us. Take care!
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Yes. This is great news. I feel so much better knowing that it was double checked and will be followed up on. Thank you so much for the support and helping me feel safe in voicing my concerns.
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