Asymmetries and architectural distortion are some of the frequent imaging findings of early breast cancer. They can be difficult to identify due to subtle and variable appearances. Both represent common findings in retrospective assessment of false-negative mammograms. Apart from malignancy, various benign breast entities can also manifest with these non-mass findings. Knowledge about the normal breast architecture and pattern is important to recognize the abnormal findings. Breast imaging ACR BI-RADS atlas (fifth edition) recognizes four types of asymmetries with variable management and presentation. Architectural distortion can arise secondary to surgery or trauma and also due to various benign and malignant breast pathologies, with clinical correlation being crucial for avoiding unnecessary interventions. Targeted ultrasound, additional mammographic views, and further imaging with magnetic resonance imaging or contrast-enhanced mammogram play a crucial role in the workup of asymmetries and architectural distortion.