Mammograms and Implants

Women with breast implants who are in an age group where routine mammograms are recommended should be sure to have these examinations at the recommended regularly scheduled times. Some women who undergo reconstruction will have some breast tissue remaining and some have all of their breast tissue removed. It is important that a woman with remaining breast tissue continue to have mammograms of that breast, as well as of the other breast, to detect breast cancer (Those who have had breast cancer surgery on both breasts should ask their doctors whether mammograms are still necessary).

Women should be aware that breast implants may interfere with the detection of cancer and that breast compression (hard pressure) during mammograms may cause implant rupture/deflation.

Interference, with mammograms, by breast implants may delay or hinder the early detection of breast cancer either by hiding suspicious lesions (wounds or injuries or tumors) or by making it more difficult to include them in the image (x-ray, ultrasound). Implants increase the difficulty of both taking and reading mammograms.

Mammograms require breast compression, which could contribute to implant rupture. According to the FDA adverse event database, there were 41 reported cases of breast implant rupture during mammograms, reported between 1992 and 2002. An additional 17 cases of breast implant rupture during mammograms were reported in the medical literature.

In addition to special care taken by the radiological technologist to reduce the risk of breast implant rupture during this compression, other techniques are used to maximize what is seen of the breast tissue during mammograms. These techniques are called breast implant displacement views, Eklund displacement views, or Eklund views, named for the radiologist who developed the techniques. These special implant displacement views are done in addition to those views done during routine mammograms.

Because of the extra views and time needed women with implants should always inform the receptionist or scheduler that they have breast implants when making an appointment for a mammogram. They should also tell the radiological technologist about the presence of implants before a mammogram is performed. Then, the radiological technologist will use these special displacement techniques and take extra care when compressing the breasts to avoid rupturing the breast implant.

The displacement procedure involves pushing the implant back and pulling the breast tissue into view. Several factors which may affect the success of this special technique, in imaging the breast tissue in women with breast implants, include the location of the implant, the hardness of the capsular contracture and the amount of the breast tissue compared to the implant size.

Also, when reading the mammogram, the radiologist may find it difficult to distinguish calcium deposits in the scar tissue around the implant from a breast tumor. Occasionally, it is necessary to remove and examine a small amount of tissue (biopsy) to see whether or not it is cancerous. Frequently, this can be done without removing the implant.

As a last note, FDA does not consider mammograms an adequate means of detecting implant rupture/deflation for silicone gel-filled breast implants. As described in the Local Complications & Reoperations ( Rupture/Deflation of Silicone Gel-Filled Breast Implants ) section, FDA believes that MRI is currently the best method for detecting implant rupture for silicone gel-filled breast implants.

Source: FDA Breast Implant Consumer Handbook

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