Breast implants are becoming increasingly popular in Colorado so many of my patients have questions regarding the safety and effectiveness of mammograms. Many women of all ages are having implant surgery for a number of reasons:
- To enhance or balance out the body to feel more proportionate
- To restore your original look after having a baby (mommy makeover)
- To improve the position of the breasts affected by age and gravity
- To reconstruct the breast or breasts as part of breast cancer treatment
- To correct asymmetry from inherited conditions such as hypo development of the breast
How is a Mammogram Performed if I Have Breast Implants?
In a typical screening (preventative) mammogram, two mammogram views are performed of each breast. Most mammograms in Colorado are 3D so each view represents multiple angles at each position. The standard positions are medial lateral oblique (MLO) which is almost side to side but includes some of the tissue under the arm. The other view is called cranial-caudal (CC) which literally means “head to tail” or up and down.
- If you have implants, there is an additional image for each view. For example, the MLO view will consist of the regular view with the implant in the picture AND an added view where the tissue in front of the implant is imaged but not the implant (called displaced). This allows the technologist to obtain better compression of different areas and allows the radiologist to see around the implant better.
These special views are sometimes called Eklund views after the radiologist who invented this technique. Earlier versions of mammograms at the time this technique was invented were all 2D so this was really the only way to visualize the breast in most women with implants. Now that most Mammogram Centers use 3D mammography, we are able to obtain more angles but these special views are still used for most women with implants. Some women may need modified images to reduce x-ray over their lifetime or prevent a known implant rupture from worsening. We recommend a supplemental ultrasound to complete this modification.
Will a Mammogram Rupture my Implants?
Implants were designed with the knowledge that almost all women who have implants will be having years of mammograms to look for cancer during their screening lifetime. Therefore, breast implants are designed to withstand at least 175 pounds of pressure (saline), and most newer generation silicone implants are made to withstand up to 300 pounds. The pressure of a mammogram is only a small fraction of this manufacturer’s specification so implant rupture is very uncommon in most implants less than 10 years (the warranty of most implants) and still rare after ten years.
Unfortunately, man-made materials are not made to last forever, and the risk of rupture increases with the age and type of the implant.
- The American College of Radiology recommends that women with breast implants undergo screening or diagnostic mammograms in spite of their small risk of rupture as the benefit of finding a cancer early significantly outweighs the small risk of a rupture.
When ruptures do occur from mammography, they are usually in older implants where the man-made material (silicone envelope) has degraded. Women with implant ruptures should consult their plastic surgeon to determine the next steps – either observation or replacement.
What Kind of a Center Performs Mammograms for Implants?
Most radiology centers have technologists who can perform these specialized views called “implant and displaced views”. Look for an imaging center that specializes in breast or women’s imaging. The technologist will work with your body to position you for the implant and displaced images, just like they would with a patient who does not have implants. If your community radiology center does have a technologist with this experience, ask your clinician to refer you to a breast center that performs this regularly.
What Do I do if I think My Implants are Ruptured?
If you ever have a concern about your breast OR breast implants, tell the scheduler AND your technologist. You may ask your clinician to order a breast ultrasound first or consult with the radiologist on site. If there is a breast concern, a diagnostic ultrasound or a mammogram may be performed. A radiologist with special training in breast or women’s imaging should be on-site to talk with you or examine you if needed. Look for a Center that has this.
- Sometimes it may be difficult to tell if the breast itself or the implant is the problem. For example, if you are involved in a car accident and the airbag injures the breast, the radiologist will want to evaluate the integrity (whether the implant is intact or not) and the space around the implant for fluid-like hematoma, and the breast itself for a contusion.
Don’t Assume that every Breast Concern is Related to Your Implants
Our first priority in breast imaging is to look for breast cancer. Many women with implants find it easier to evaluate for breast problems such as masses, pain, or skin dimpling. However, some women may be less aware of their surgically altered breasts and can disregard changes that may be important.
- Some implant concerns turn out to be problems in the breast, and not related to the implants.
If we find a suspicious find within the breast, we can always do more testing including a biopsy to determine if the problem is benign (noncancerous) or cancer.
What if I Need a Breast Biopsy and I have Implants?
Most implants are surgically placed under the pectoralis muscle which helps in performing mammograms. If an image-guided breast biopsy is required, the implant positioned behind the muscle helps give more space to work, but there is always a small risk of implant injury in any kind of breast biopsy. Many factors determine how we might choose to perform a biopsy in the breast with implants.
- Your physique, age, size of the implants, and whether you have had implants before in this pocket are all important factors. The pectoralis muscle provides more of a space buffer if a lesion is biopsied in the upper part of the breast.
Many women have little muscle or fascia covering the implant along the lower portion of the breast, so biopsies of lesions in these positions may have a greater risk (still very small) of injury to the implant. Radiologists specializing in high-volume diagnostic breast or women imaging will be best able to discuss the benefits versus risks of performing a biopsy with you. They may use either ultrasound, mammography (called a stereotactic biopsy), MRI-guided, or refer you for a surgical biopsy depending on the location and accessibility of the lesion.
- This is where experience matters. If you live in a smaller community or typically go to a hospital for your mammograms, you may be sent to a facility that specializes in diagnostic mammography and biopsy.
About the Author:
The author of this article is the Medical Director and Chief Radiologist of The Women’s Imaging Centers throughout the Denver metro area. For over thirty years, Dr. Kelly McAleese has been a lifelong advocate for women’s health issues and access for all Coloradans. She has published numerous articles on the topics that affect women’s health and is nationally recognized as one of the founding members of the concept of Women’s Imaging.
