The presence of breast implants, whether saline or silicone gel, challenges standard breast cancer screening methods. The implant material is radiopaque, meaning it obstructs the view of underlying breast tissue on an X-ray, potentially hiding small tumors. This obscuring effect makes it difficult for radiologists to accurately visualize all natural breast tissue during a routine examination. However, modified techniques have been developed to ensure proper visualization and detection. These specialized methods safely move the implant out of the imaging path or use alternative technologies, ensuring thorough and timely cancer surveillance.
Adjusting Your Breast Self-Examination
Performing a regular breast self-examination requires adapting the technique when implants are present. The primary goal is distinguishing the smooth, firm edges of the implant from the surrounding natural glandular tissue. Familiarity with the feel of your implants and any firm scar tissue is important for noticing new changes.
It is recommended to perform this examination while lying down, as this position helps spread the breast tissue more evenly across the chest wall. Use the pads of three fingers, applying gentle but firm pressure to systematically check the entire breast area, including the armpit and up to the collarbone. Focus intently on the periphery of the breast, which is the tissue wrapping around the implant.
A modified technique involves gently displacing the implant to fully expose the tissue in front of it. By carefully pushing the implant capsule toward the chest wall, you can better palpate the natural breast tissue for any unusual lumps or thickening separate from the implant’s texture. Any new or persistent change, such as swelling, dimpling of the skin, or nipple discharge, should prompt an immediate discussion with a healthcare provider.
Navigating Mammography With Implants
Mammography remains the primary screening tool, but the standard four-view procedure is insufficient when implants are present. The implant can hide up to 85% of the breast tissue from the X-ray beam, significantly reducing the exam’s sensitivity. Specialized screening is required to ensure maximum glandular tissue visibility.
The specialized protocol is known as the Implant Displacement View, often called the Eklund views. This technique involves the technologist gently pushing the implant backward against the chest wall. Simultaneously, the natural breast tissue is pulled forward onto the compression plate for imaging. This maneuver separates the soft tissue from the implant material, allowing for effective compression and clear visualization.
A standard screening mammogram includes two views of each breast. Using the implant displacement technique, four additional views are typically taken for each breast, resulting in a total of eight images. This doubles the number of pictures analyzed by the radiologist. It is important to seek facilities and technologists experienced in performing Eklund views, as the procedure requires skill to protect the implant while maximizing tissue exposure. Although there is concern about implant rupture, the compression used during the Eklund maneuver is gentle and adapted, making complications extremely rare.
When Advanced Imaging is Necessary
While specialized mammography is the first line of defense, advanced imaging modalities supplement screening or provide definitive diagnostic information. These tools are useful when mammography results are inconclusive or when a high degree of certainty is required to evaluate a suspicious area.
Breast ultrasound is a highly effective, non-invasive technique that uses sound waves to create images of the breast tissue. It is frequently employed as a follow-up to mammography, especially in patients with implants, to characterize a palpable lump or a partially obscured area of concern. Ultrasound excels at differentiating between solid masses, which may be cancerous, and simple fluid-filled cysts, which are typically benign. It also provides a clear view of the tissue immediately adjacent to the implant.
Magnetic Resonance Imaging (MRI) is considered the most sensitive tool for breast cancer detection in women with implants, particularly those at high lifetime risk. The MRI provides a detailed, three-dimensional image of the breast, allowing a clear view of tissue near the chest wall and behind the implant—an area difficult to assess with other methods. MRI is also the gold standard for accurately assessing the structural integrity of silicone implants. For surveillance, the Food and Drug Administration recommends a non-contrast MRI to check for silent silicone implant rupture starting five to six years after placement, and then every two to three years thereafter.