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Difference between tethering puckering and dimpling in breast cancer (Explained)

Difference between tethering puckering and dimpling in breast cancer (Explained)

After your breast cancer surgery, you may be wondering how to take care of your breasts in order to ensure they look as natural as possible.

It’s important to know that all three methods have their own advantages and disadvantages, but it’s also imperative that you understand what the differences are between plucking, tethering, and dimpling the breasts during breast cancer so you can choose the best method for you.

To better understand the difference between the three, it’s important that you first have a deep understanding of breast cancer. So this article will tell you what breast cancer is, its symptoms, and how it is treated and diagnosed.

Further, I’ll also explain what plucking tethering and dumpling are.

A microscopic image of a cancer cell
A microscopic image of a cancer cell

What Is Breast Cancer?

Breast cancer is the second most diagnosed skin disease in women. Although it can occur in both males and females, we have noticed that it occurs far more in females than in males.

Breast cancer forms when the cells inside the breast start to grow abnormally and grow too large. These cells then divide more than the healthy cells which results in the formation of a lump or mass of cells. The breast has three main parts: lobules, ducts, and connective tissues.

Cancer can originate from any of these parts depending on which parts cells started to grow abnormally before. Cancer can spread to other parts of the body too if not treated fast.

The cancerous cells travel across the body through blood vessels. There are multiple types of breast cancers. The type of breast cancer depends on which cells in the breast turn into cancer.

  • TypeDuctal carcinoma in situ (DCIS)
  • Invasive breast cancer (ILC or IDC)
  • Triple-negative breast cancer
  • Inflammatory breast cancer
  • Paget disease of the breast cancer
  • Angiosarcoma
  • Phyllodes tumors of breast cancer
A video on understanding breast cancer and its causes

Symptoms of Breast Cancer

The symptoms of breast cancer vary from person to person. Some people don’t even see or experience any symptoms which makes this disease even more dangerous.

The main and most common symptoms of breast cancer are the following:

  • The formation of lumps in the breast or armpit
  • Pain in the breast
  • The formation of a flattened area on your breast
  • The appearance of the nipple changes
  • Swelling rashes or other changes are observed in the skin
  • Nipples start to release blood
  • Part of the breast starts to swell and get thicker
  • Newly inverted nipple

Diagnosis of Breast Cancer

Doctors use various tests to detect whether you have breast cancer or not. They may refer you to a breast doctor as these people are professionals and skilled in testing patients for breast cancer

Doctors consider a few things about you and your medical condition before selecting the appropriate tests for you. This is because not all tests are practiced on all people.

The factors which the doctors consider are your age the symptoms you have and the type of breast cancer you are suffering from. Next, they perform a series of tests:

Breast ultrasound

Ultrasound uses sound waves to create images of the inside of the breasts and tissues of the body. It helps doctors decide whether a new lump in the breast is a solid mass or a fluid-filled cyst.


A biopsy is the most important method of diagnosis because it can give experts a definite answer to whether the person has breast cancer or not.

In a biopsy, a thin needle guided by an X-ray is pierced into the patient’s body and fluid or tissue is extracted from the area suspected to have cancer. These tissue samples are then sent to a lab where they are analyzed and tested. Experts then determine whether the cells are cancerous or not.


An MRI is different from other imaging tests as it does not use X-rays. It uses a magnet and radio waves to create images inside your breast and body. A special type of dye called a contrast medium is injected into your body. This helps to create an image of possible cancer.

An MRI test is used for multiple purposes. Firstly, it is used when a person has already been diagnosed with cancer to see how much cancer has spread or if the second breast has been infected by cancer or not.

Secondly, it is also used as a screening option along with mammography for women who have a very high chance of having breast cancer or women who have already had breast cancer in the past. Lastly, it is used as a checking method on patients who have been diagnosed and treated already

Diagnostic mammography

If patients develop problems like a lump, nipple discharge like blood, or the area around the breast looking abnormal doctors recommend a diagnostic mammography test. This test is an advanced version of an X-ray and it’s used to form even deeper and clearer images of the insides of the breast.

Breast exam

The doctor examines both of your breasts and armpits for signs such as lumps or other abnormalities like a larger area around your breasts or nipple discharge.

A video about the symptoms and treatment of breast cancer

Treatment of Breast Cancer

There are various different methods of treating breast cancer like surgery, radiotherapy, chemotherapy, hormone therapy, and targeted therapy.

The doctors may give the patient one of these treatments or even combinations of these various treatments. The type of treatment you receive depends on the type of breast cancer you have, your general health, past medical records, the type of symptoms you are experiencing, and the stage your breast cancer is at.

After deciding all of this the doctor will begin your treatment. The main and most common forms of treatment are the following:

Breast surgery

Breast surgery is the most common treatment for breast cancer. It involves cutting off different parts of the breast. The two most common types of breast surgeries are mastectomy and breast-conserving surgery


Mastectomy is the method of breast surgery in which your entire breast tissue is removed including the soft skin, lobules, duct, and nipple. You may have a mastectomy if the cancer hasn’t spread to your lymph nodes. In some cases of mastectomy where the cancer isn’t too extreme modern equipment is used to maintain the good appearance of the breast

Breast-conserving surgery

In this surgery, the doctor removes the tumor from your breast along with a small amount of the surrounding tissues. The tissues are tested for cancer and if cancer cells are found in the surrounding tissue then more tissue will have to be removed. This surgery is ideal for the removal of small-sized tumors.


Chemotherapy uses drugs or anticancer medicine to kill abnormally growing cancer cells. The purpose of chemotherapy is to make sure that the remaining cancer cells after surgery are eliminated and to reduce the chances of cancer reoccurring in your body. This treatment is therefore used after surgery.

Only in cases of large tumors, chemotherapy is given to you before surgery. You’re given about 2 to 3 drugs. The type of drugs given depends on the stage of your cancer. The treatment is an outpatient treatment which means you won’t be required to stay in the hospital. Sometimes drugs or tablets are given to the patients.

Chemotherapy is used to fight against cancer cells and stop cancer from spreading. Chemotherapy is an effective treatment however it also comes at a cost. It has several side effects including:

  • hair loss
  • nausea
  • vomiting
  • fatigue 
  • infections
  • tiredness
  • postponed periods
Doctor and nurses operating on a patient suffering from breast cancer
Doctor and nurses operating on a patient suffering from breast cancer


Breasts that have puckering in them are simply referred to as puckered breasts. The puckering will occur most often on one side of each breast.

When breast cancer occurs, a lump will develop and tissue from around it might also be present. These lumps may protrude from your skin, which causes your breast to have an unusual shape or an uneven appearance.

This is why puckering in breasts can also be described as dimpling in breasts, because dimpling is an extra crease that has been formed in your breasts due to puckering in your breast skin and tissue.

Puckering can happen at any time, but it becomes more common after menopause. It also happens when you gain weight or if you’ve had children and breastfed them for some time. Women who have had mastectomies may experience puckering in their reconstructed breasts as well.


A tether refers to a grouping of lymph nodes that are located close together. As we discussed earlier, women who undergo mastectomies often report feeling a lump or thickening at what is called the inframammary fold—the crease under their breasts where breast tissue transitions into fatty tissue.

This isn’t abnormal; rather it indicates that you have a tether. These nodules are all attached to one another and are ultimately joined by a single string of tissue. As such, they can be thought of as individual groups of glands on one long stalk.

 If you feel like there’s a tight band around your chest under your breast or under your arm (or both), then you probably have tethers and should mention them to your physician.


The appearance of dimpling can sometimes be found in one or both breasts. The dimples are usually caused by thinning of underlying muscle fibers, which is called pectoralis muscle atrophy. Dimpled tissue may be softer than normal breast tissue but not necessarily.

A mammogram will likely show smaller pockets of fluid (called microcalcifications) scattered throughout dimpled tissue. These microcalcifications are an indication that there’s increased breast density but they don’t mean that cancer has spread to the tissue under them.

They also don’t affect a breast cancer diagnosis or prognosis in any way; what matters most is whether or not cancer cells have spread from where they started (i.e., from ducts or lobules).

The Difference Between Tethering Puckering And Dampering in Breast Cancer

The difference between plucking tethering and dimpling in the breast during breast cancer is how much of the skin around the nipple is removed.

Puckering is a change in the texture of skin surrounding the breastDimpling is a change in the skin of the breastSkin tethering tends to pull the overlying skin inwards causing a visible dimple that looks similar to orange peel.
Puckering is a visual change noted when the woman raises her armsDimpling is a visible change that occurs in the breastTethering is how the tissues feel. The mass of tissue is mobile
Puckering vs. Dimpling vs. Tethering


Plucking may mean removing just a small area or it may mean removing several millimeters of skin from the surrounding tissue. If it extends beyond the immediate area, plucking can result in dimpling in an areola (the pigmented area around the nipple).


Dimpling occurs when the underlying tissue is exposed and there’s no additional skin covering it. In some cases, both plucking and dimpling occur simultaneously. The differences between these two procedures may be based on what’s considered medically necessary to remove abnormal cells.

Dimpling is caused by plucking in areas that go past where the tissue was originally located which leaves the underlying cells exposed without any other protective layer. When this happens, there will likely be one more visible depression than if they were only done separately because they happened at different times and not together like dimpling would have been before being repaired with sutures


Tethering also called skinning involves taking skin from all around the nipple-areolar complex up to six centimeters in diameter. It can be done as a one-step procedure or as part of a mastectomy.

Tethering may also be done as part of reconstructive surgery after breast reconstruction for those who have had partial mastectomies and then reconstructed with implants.


  • Breast cancer is a deadly disease that has many effects like puckering dimpling and tethering. It is important that you know the differences between the three of these so you can take better care of yourself
  • Breast cancer is caused due to the abnormal growth of cells. It has many symptoms you should keep an eye for these signs and consult a doctor immediately
  • Various methods of treatment exist. Depending on your medical condition you are treated with the most effective method for you.

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