A mammogram is a specialized X-ray used to screen for breast cancer by capturing images of the internal breast tissue. Breast implants are medical devices, filled with saline or silicone, placed behind the natural breast tissue or chest muscle. Women with implants should continue to follow standard breast cancer screening guidelines. Yes, you can get a mammogram with breast implants, but the procedure requires a modified approach using specific imaging techniques to maximize the visualization of the surrounding breast tissue.
Specialized Techniques for Imaging Implanted Breasts
The presence of an implant requires the mammography technologist to perform a modified set of images to properly visualize the breast tissue. Standard full compression cannot be used because the implant material would obscure the underlying breast tissue, making interpretation difficult. Instead, specialized views known as implant displacement views, often called the Eklund technique, are utilized.
This technique involves gently pushing the implant backward toward the chest wall while pulling the natural breast tissue forward. This maneuver isolates the breast tissue, allowing the compression paddles to flatten only the tissue in front of the implant, which improves visualization. The implant displacement views are added to the standard two-view mammogram (top-to-bottom and angled views).
The total number of images taken during a screening mammogram with implants is typically doubled, from the standard four images (two per breast) to eight images. These four extra displacement views are necessary for capturing the tissue that would otherwise be hidden by the opaque implant. This procedure requires a highly skilled technologist to ensure maximum tissue visualization and patient comfort.
Assessing the Risk of Implant Rupture
A common concern is the risk of the implant rupturing due to the compression applied during the mammogram. Compression is necessary to spread the tissue and reduce the X-ray dose. The specialized Eklund technique is designed to minimize direct pressure on the implant by isolating the breast tissue away from the implant before compression is applied.
The risk of implant rupture during a mammogram is considered extremely low, especially with modern, durable implants. Implant shells are constructed to withstand significant pressure, and the force applied during the specialized views is carefully controlled. Patients should inform the technologist about the implant type (saline or silicone) and its location (over or under the muscle), as this information helps tailor the technique appropriately.
Impact on Diagnostic Accuracy
Despite the use of specialized displacement views, breast implants can still affect the diagnostic accuracy of a mammogram. The implant material, particularly silicone, is dense and opaque to the X-ray beam, blocking the view of breast tissue located behind it. This obscuring effect can potentially hide small cancers developing in the posterior breast tissue.
While displacement views effectively capture the anterior, lateral, and medial portions of the breast tissue, a small percentage of tissue closest to the chest wall may remain obscured. This limitation can slightly reduce the overall sensitivity of the mammogram compared to women without implants.
Radiologists are trained to identify specific signs of concern within the limited visible tissue and understand the limitations imposed by the implant. The primary diagnostic challenge is the inability to visualize 100% of the glandular tissue, making supplemental screening methods important for this patient population.
Supplemental Screening Options
Due to the potential for implants to obscure some breast tissue, physicians often recommend supplemental imaging in addition to the annual mammogram. These tools help compensate for areas the X-ray cannot penetrate, ensuring a more comprehensive screening.
Breast Ultrasound
Breast ultrasound is the most common supplemental screening tool used for women with implants. It uses sound waves rather than X-rays to create images, allowing for a clear view of the dense tissue and the implant itself. Ultrasound is useful for evaluating the tissue immediately surrounding the implant and differentiating between a solid mass and a fluid-filled cyst. It is often performed following a mammogram if the radiologist needs to investigate a partially obscured area.
Magnetic Resonance Imaging (MRI)
MRI is another highly sensitive option, especially for women with silicone implants. MRI is recognized as the best imaging modality for evaluating the integrity of silicone implants to detect silent ruptures. For women at high risk for breast cancer, an annual breast MRI is often recommended as a robust screening tool that provides excellent soft-tissue contrast, regardless of the implant’s presence.