Mammography Guidelines for Women w

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Breast Implant Imaging

• Mammography Guidelines for Women with Breast Implants
• Mammography Guidelines for Following Breast Reduction Surgery
• Magnetic Resonance (MR) Imaging of Breast Implants

• Ultrasound Imaging of Breast Implants
• Breast Biopsy for Women with Implants

Women with breast implants should follow the same American Cancer Society (ACS) program of recommended mammograms as women without breast implants (click here to view the ACS guidelines). However, due to the implant, several special mammography views must be taken to allow visualization of both the breast tissue and the implant. For this reason, diagnostic mammography is usually performed on patients with breast implants (as opposed to screening mammography that is typically performed on asymptomatic women without implants).

Examination of the augmented breasts is more time consuming; therefore, the imaging location performing the mammography should be informed of the presence of implants when the mammogram is scheduled. Patients with implants should also inform the physician and the technologist performing the exam that they have implants. Imaginis.com is unaware of any documented cases where mammography has been the direct cause of implant rupture.

The x-rays used for mammographic imaging of the breasts cannot penetrate silicone or saline implants well enough to image the overlying or underlying breast tissue. Therefore, some breast tissue (approximately 25%) will not be seen on the mammogram, as it will be covered up by the implant. In order to visualize as much breast tissue as possible, women with implants undergo four additional views as well as the four standard images taken during diagnostic mammography. In these additional x-ray pictures, called Eklund views or implant displacement (ID) views, the implant is pushed back against the chest wall and the breast is pulled forward over it. This allows better imaging of the forward most part of each breast. The implant displacement views are not as successful in women who have contractures (formation of hard scar tissue around the implants). The ID views are easiest to obtain in a women whose implants are placed underneath (behind) the chest muscle.

Standard mammography views are taken first. The breast and implant are compressed with moderate force	Image displacement mammography views (also called Eklund views) are performed with the implant pushed back against the chest wall. The compression paddle is applied to the breast tissue, which is pulled forward.

Women who have had breast contouring orbreast reduction (also called mastopexy or reduction mammaplasty) should also receive annual mammograms once they reach 40 years of age. It is important for the radiologist to be aware of the patient's surgical history. This will help the radiologist when they interpret the mammogram images.

Magnetic Resonance (MR) imaging of the breasts (also called MR Mammographyor Breast MR1) can be used to image breast implants to check for ruptures or leaks. MR imaging may also be used as an adjunctive tool to conventional mammography for women with implants.

MR imaging gives radiologists significant freedom in acquiring direct views of the breasts in any plane or orientation. This is because the MR system switches magnetic fields and radio waves to achieve the acquisition of different views while x-ray mammography requires re-orientation of the breast and mammography system for each view desired. MR also allows the doctors to easily visualize the muscle and chest wall in the vicinity of the breast, which may be important to check for the spread of cancer.

MR imaging can also be used to image breast tissue and cosmetic implants. Implants can obscure some of the breast tissue on conventional x-ray mammography images. This is because x-rays used for mammographic imaging of the breasts cannot penetrate silicone or saline implants well enough to image the overlying or underlying breast tissue. MR imaging does not have this limitation.

MR mammography can image the breast tissue that is compressed by an implant. However, x-ray mammography is still the best tool for evaluating breast tissue and for screening and diagnosing breast cancer. MR mammography requires intravenous contrast (gadolinium), is much more expensive than conventional mammography and has limitations in sensitivity and specificity. There is no routine recommendation for using MR imaging as a cancer screening tool in women with implants, although it can be helpful in selected cases.

Magnetic resonance is the imaging method of choice to evaluate breast implants and to check for ruptures or leaks. MR imaging provides very good spatial resolution (detail) and excellent contrast resolution and enables MR to clearly visualize implant condition.

Transverse high-resolution MR mammography of breast and implants.
Note the implant twisting on the upper (left) image and the implant valve on the lower (left) image

Breast ultrasound may also be used as a screening tool for the detection of implant rupture or leak. However, the sensitivity and specificity of ultrasound is lower than magnetic resonance imaging since ultrasound typically provides lower spatial resolution and less contrast resolution than MR. Ultrasound imaging is usually less expensive than MR imaging. MR imaging can also be more time consuming than ultrasound. Some patients may also prefer ultrasound over MR imaging, which some find to cause claustrophobia and mild anxiety.

Vacuum-assisted biopsy (brand names, Mammotome or MIBB) allows physicians to perform accurate breast biopsies on women with breast implants. Prior to the advent of vacuum-assisted biopsy, women with implants typically had to undergo open surgical biopsy if breast cancer was suspected.

Unlike surgical biopsy, vacuum-assisted biopsy is a percutaneous ("through the skin") procedure. Vacuum-assisted biopsy relies on stereotactic mammography or ultrasound imaging for guidance. Stereotactic mammography involves using computers to pinpoint the exact location of a breast mass based on mammograms (x-rays) taken from two different angles. The computer coordinates will help the physician to guide the needle to the correct area in the breast. With ultrasound, the radiologist or surgeon will watch the needle on the ultrasound monitor to help guide it to the area of concern.

The precision and directional abilities of vacuum-assisted biopsy make it the most viable percutaenous ("through the skin") biopsy option for women with breast implants. Conventional core needle biopsy is typically less precise in locating breast abnormalities (lesions) and requires multiple needle insertions in order to obtain adequate breast tissue samples. Due to these limitations, core needle biopsy has been problematic in the past for women with breast implants.

Vacuum-assisted breast biopsy provides a safer approach for women with implants. Unlike core needle biopsy, the vacuum-assisted biopsy probe is inserted just once into the breast through a small nick in the skin. Multiple tissue samples may be taken by rotating the sampling needle aperture (opening) and using vacuum assistance. The placement of the vacuum-assisted biopsy needle is carefully manually positioned between the implant and breast abnormality (lesion).

Click here to learn more about breast biopsy.

Updated: July 2006