From the Guidelines
Mammograms are not recommended after a complete mastectomy, but are necessary for the remaining breast in patients who have undergone a unilateral mastectomy. When the entire breast tissue is removed during a mastectomy, there is no remaining breast tissue to examine with mammography 1. Instead, post-mastectomy follow-up typically involves physical examinations, possibly ultrasound of the chest wall, and in some cases, MRI imaging. However, if you've had a skin-sparing or nipple-sparing mastectomy, your doctor might recommend some imaging surveillance of the small amount of remaining tissue.
Key Points to Consider
- For patients who have undergone a unilateral mastectomy (removal of only one breast), regular mammograms are still necessary for the remaining breast 1.
- The typical recommendation is to continue annual mammograms for the unaffected breast 1.
- After mastectomy, your oncologist or surgeon will establish an appropriate surveillance plan based on your specific situation, cancer history, and risk factors 1.
- This plan may include regular clinical breast exams every 6-12 months for the first few years after surgery 1.
- The rationale behind avoiding mammograms after complete mastectomy is simply that the procedure is designed to image breast tissue, and when that tissue has been completely removed, the test no longer serves its purpose 1.
Surveillance Recommendations
- Annual mammography on the intact breast is recommended for women who have received a unilateral mastectomy 1.
- Routine screening with MRI of the breast is not recommended unless the patient meets high risk criteria for increased breast cancer surveillance as per ACS guidelines 1.
- Imaging for breast cancer screening is usually not appropriate for a female with history of cancer and no reconstruction on breast(s) that underwent mastectomy 1.
From the Research
Mammogram Post Mastectomy
- A mammogram after a mastectomy is a topic of debate among breast imagers, with some believing it is not beneficial due to the low yield of finding recurrent cancer in asymptomatic patients 2.
- However, others argue that imaging should be performed on these patients due to the existing risk of recurrence.
- Patients who have undergone a mastectomy are considered high-risk, and when they present with clinical symptoms, evaluation by a radiologist is required 2.
- In the diagnostic or symptomatic scenario, imaging tools such as mammography, ultrasound, and magnetic resonance imaging (MRI) can be used to diagnose recurrent cancer.
Imaging Modalities
- A study comparing the diagnostic performance of MRI, ultrasound, and mammography for breast cancer detection found that MRI had the highest sensitivity, while mammography had the lowest sensitivity 3.
- The study also found that combining imaging modalities, such as MRI and ultrasound or MRI and mammography, increased diagnostic ability compared to using modalities alone.
- Another study found that MRI was more accurate than ultrasonography or mammography for assessing the size of primary breast cancer presenting as a mass 4.
Recommendations
- There is no clear recommendation for routine mammography after a mastectomy, but imaging may be beneficial in certain cases, such as when clinical symptoms are present or when there is a high risk of recurrence 2, 3.
- The choice of imaging modality depends on various factors, including tumor type, breast density, and patient history 3.
- Further research is needed to determine the best approach for breast cancer screening and diagnosis in patients who have undergone a mastectomy.