A mammogram is an X-ray screening tool that uses low-dose radiation to capture images of the breast tissue, designed to detect early signs of breast cancer. While implants do not prevent a person from receiving a mammogram, the procedure must be adapted. This adaptation ensures both the safety of the implant and the diagnostic quality of the images, allowing for effective screening, which remains a standard recommendation.
Specialized Techniques for Imaging Implanted Breasts
The primary challenge in imaging an augmented breast is that the implant itself is opaque to X-rays, meaning it can partially obscure the view of the native breast tissue behind it. To address this, specialized positioning is used to maximize the visualization of glandular tissue. This adaptation is commonly referred to as the implant displacement view, or the Eklund technique.
The technique involves the technologist gently pushing the implant backward toward the chest wall while pulling the maximum amount of natural breast tissue forward onto the compression plate. The goal is to isolate the native breast tissue for compression and imaging, leaving the implant out of the direct field of view. This procedure requires a high degree of skill and experience from the mammography technologist.
A standard screening mammogram typically involves taking four images, two of each breast. When the implant displacement technique is used, four additional views are taken, resulting in a total of eight images. These extra images, called implant-displaced views, are crucial for ensuring that the largest possible area of breast tissue is captured. The overall examination may take slightly longer due to the extra positioning and imaging required.
Understanding the Risk of Implant Rupture
A common concern for patients is whether the compression necessary for a mammogram could cause the implant to rupture. The risk of rupture is considered extremely low, particularly when the specialized implant displacement views are performed by a trained technologist. Modern breast implants are engineered with durable shells designed to withstand pressure.
It is helpful to inform the technologist about the specific details of the implants, including whether they are filled with saline or silicone and their placement (subglandular or submuscular). This information allows the technician to adjust the compression and positioning to follow specific protocols that minimize any potential risk. In rare instances where an implant is already weakened, the pressure might reveal the issue, but it is not typically the cause of an intact implant’s failure.
The risk of not screening for breast cancer far outweighs the minimal risk of implant damage. Although compression is necessary to spread the tissue and obtain a clear image, the implant displacement maneuver often results in softer compression on the implant itself because the force is focused on the native tissue. Following the standard screening guidelines is the recommended course of action for maintaining breast health.
The Role of Supplementary Screening Tools
While the Eklund technique significantly improves the visualization of breast tissue, the presence of an implant can still obscure a percentage of the breast tissue from the X-ray. Studies indicate that between 22% and 83% of the glandular tissue may be obscured, creating a potential blind spot for small tumors. This limitation often necessitates the use of supplementary imaging tools to ensure a comprehensive screening.
Breast ultrasound is frequently used as a complementary tool after a mammogram. This imaging method uses sound waves instead of X-rays, and because there is no compression, it is effective for evaluating areas difficult to visualize on the mammogram. Ultrasound is also effective for distinguishing between solid masses and fluid-filled cysts, and it is routinely used to assess the integrity of the implant for signs of silent rupture.
Breast Magnetic Resonance Imaging (MRI) is considered the most sensitive tool for screening the augmented breast, especially for viewing the tissue located directly behind the implant. MRI is the standard for detecting silicone implant rupture, which can often be “silent,” showing no outward symptoms. Because MRI does not use radiation and offers high contrast resolution, it can detect small lesions that might be missed by other methods.
MRI is reserved for women considered at high risk for breast cancer or when the mammogram and ultrasound results are inconclusive. While effective, breast MRI is more expensive, time-consuming, and less accessible than other methods. For most women with implants, a combination of a modified mammogram and a targeted ultrasound provides a robust approach to breast cancer screening.