From the Guidelines
Women with encapsulated breast implants should continue regular breast cancer screening, with some modifications to standard procedures, prioritizing mammography as the primary screening tool, and considering additional views and complementary methods like ultrasound and MRI as needed, as recommended by the most recent guidelines 1.
Breast Cancer Screening Recommendations
- Mammography remains the primary screening tool, but additional views (called Eklund or implant displacement views) are typically required to visualize as much breast tissue as possible.
- These views involve pushing the implant back and pulling the breast tissue forward, and both standard craniocaudal and mediolateral oblique and implant-displaced views should be obtained.
- Standard screening mammography should be performed every 1-2 years for women over 40, or earlier if there are additional risk factors, as outlined in the ACR Appropriateness Criteria topics on “Breast Cancer Screening” 1.
Complementary Screening Methods
- Ultrasound may be used as a complementary screening method, particularly for women with dense breast tissue or when mammography results are inconclusive.
- For high-risk women or those with inconclusive results from other methods, MRI might be recommended, as it is useful in detecting extracapsular silicone and can reveal high-density free silicone outside the expected contour of the implant 1.
Clinical Breast Exams and Self-Exams
- Regular clinical breast exams by a healthcare provider, typically annually, are also crucial.
- Women should perform monthly breast self-exams, familiarizing themselves with the feel of their breasts with implants to detect any changes.
Importance of Adhering to Screening Schedules
- It's essential to note that while implants can make screening more challenging, they do not increase the risk of breast cancer, but may mask small tumors, making early detection potentially more difficult, as highlighted in the guidelines 1.
- Women should inform their healthcare providers and mammography technicians about their implants to ensure proper screening techniques are used, and comparison with prior mammograms is useful to identify subtle contour changes over time, which potentially indicate a problem with implant integrity 1.
From the Research
Breast Cancer Screening in Patients with Encapsulated Breast Implants
- There are no specific breast cancer screening recommendations for patients with breast implants, but special mammographic views are indicated to enhance accuracy 2.
- Mammography may be less sensitive in women with implants, but it remains the most reliable tool for diagnosing early breast cancer in these patients 3.
- Alternative imaging modalities, such as contrast-enhanced mammography (CEM), may be feasible and effective in women with breast implants 4.
- Patients with silicone breast implants should undergo routine screening for implant rupture with magnetic resonance imaging or ultrasonography completed five to six years postoperatively and then every two to three years thereafter 2.
- Implant-related adverse events, such as rupture, pain, and impaired visualization, may occur during mammography, but the risk is extremely low and should not prevent patients from adhering to breast cancer screening programs 5.
Recommendations for Breast Cancer Screening
- Women with breast implants should discuss screening options with their breast cancer screening team 5.
- Magnetic resonance imaging and breast ultrasound may be useful adjuncts to mammography in women with implants 3.
- Contrast-enhanced mammography may be a viable alternative to magnetic resonance imaging as a diagnostic or screening exam in women with breast implants 4.
- Healthcare professionals should be aware of the potential risks and complications associated with breast implants and take steps to ensure appropriate screening and care for patients with these devices 6.