As breast cancer advances, it causes fibrosis (scar tissue). Shortening of this fibrotic tissue produces retraction signs, including dimpling, changes in contour, and retraction or deviation of the nipple. Other causes of retraction include fat necrosis and mammary duct ectasia.
Look for this sign with the patient's arm at rest, during special positioning, and on moving or compressing the breast, as illustrated here.
Edema of the skin is produced by lymphatic blockade. It appears as thickened skin with enlarged pores—the so-called peart d'orange (orange peel) sign. It is often seen first in the lower portion of the breast or areola.
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