A mammogram is a specialized X-ray screening tool used to look for signs of breast cancer. When breast implants are present, the procedure requires adjustments to ensure the natural breast tissue is adequately visible for screening. The presence of implants introduces unique considerations regarding the imaging process and can raise concerns about potential discomfort during compression. Trained technologists use specialized techniques to work around the implant material, which helps maintain the diagnostic quality of the screening while addressing patient comfort.
Modified Mammography Techniques for Implants
The primary challenge in imaging an augmented breast is that the implant material, whether silicone or saline, can obscure the surrounding breast tissue on a standard X-ray. Because X-rays cannot easily penetrate the implant, a significant portion of the tissue may be hidden, potentially masking an abnormality. To counter this, the standard two-view mammogram is supplemented with a specialized method to displace the implant.
This modified procedure is known as the Eklund technique or implant-displacement (ID) views. The technologist gently pushes the implant backward against the chest wall while pulling the overlying natural breast tissue forward. This maneuver isolates the breast tissue from the implant, allowing it to be compressed and imaged separately. The standard four images (two per breast) are typically increased to eight images, providing a much clearer view of the isolated tissue.
The success of the Eklund technique relies on the implant being soft and mobile enough to be moved away from the breast tissue. This method ensures that the maximum amount of glandular tissue is visible for analysis, significantly improving the sensitivity of the screening.
Managing Compression and Discomfort
While any mammogram involves pressure, the sensation experienced with implants is slightly different due to the displacement technique. Achieving diagnostic image quality requires sufficient compression of the natural breast tissue pulled forward. Most people report the discomfort as minimal and transient, lasting only a few moments for each view.
The placement of the implant influences the sensation during the procedure. Implants placed under the chest muscle (subpectoral or submuscular placement) often allow for easier tissue displacement, which may make compression less challenging. Conversely, implants placed over the muscle (subglandular) may be more difficult to move, potentially leading to a more noticeable pressure sensation.
The presence of capsular contracture, the tightening of the scar capsule around the implant, can also heighten discomfort during compression. Technologists are trained to apply only the necessary pressure and adjust positioning as needed. Open communication with the technologist during the procedure is key to managing any acute pain or tenderness.
Ensuring Implant Safety and Integrity
A common concern is the risk of implant damage or rupture due to compression during the mammogram. Modern mammography protocols and current implant shell designs make the risk of implant rupture extremely low. Implants are engineered to withstand significant pressure and movement.
Technologists performing the exam are specifically trained to handle augmented breasts with care, applying modified compression settings for the displacement views. Both saline-filled and silicone-gel-filled implants are accommodated using the same specialized technique. The benefit of screening for early cancer detection far outweighs the minimal risk, but facilities experienced in imaging augmented breasts are preferred.
For those with silicone implants, mammography is not the ideal tool for detecting a silent implant rupture. The Food and Drug Administration recommends that women with silicone implants undergo an MRI screening a few years after initial placement and then every two years thereafter to check for silent rupture. This dedicated MRI is separate from the cancer screening mammogram.
Tips for a Smoother Mammogram Experience
Taking proactive steps before the appointment can significantly improve the comfort level of the mammogram. Always call ahead and state that you have breast implants when scheduling. This allows the facility to allocate the correct time and ensure a technologist trained in the Eklund technique is available.
Timing the screening to when your breasts are naturally less tender, typically the week following your period, may reduce overall sensitivity. You can also consider taking an over-the-counter pain reliever, such as acetaminophen or ibuprofen, about 30 to 60 minutes before the procedure to minimize discomfort.
When you arrive, inform the technologist about your specific implant details, including the type (saline or silicone) and placement (over or under the muscle). Wearing a two-piece outfit allows you to remove only your top, offering added convenience. Most importantly, communicate any pain or tenderness to the technologist so they can make immediate adjustments during the brief compression process.