Can screening mammograms be performed in women with breast implants?

From the Guidelines

Yes, screening mammograms can be performed in women with breast implants, though the procedure requires some modifications. The technologist will take additional images called implant displacement views (Eklund technique), where the implant is pushed back against the chest wall and the breast tissue is pulled forward to better visualize the natural breast tissue. Women with implants should inform the facility in advance so appropriate scheduling and techniques can be used. The presence of implants may make mammogram interpretation more challenging and can obscure some breast tissue, potentially reducing cancer detection sensitivity. Despite these limitations, mammography remains an important screening tool for women with implants. Some women with implants may experience more discomfort during the procedure due to compression of the implants, but technologists are trained to minimize discomfort while still obtaining quality images. Regular screening is particularly important since implants don't reduce breast cancer risk, and early detection remains beneficial. According to the most recent guidelines, such as those outlined in the study by 1 and 1, mammography can identify extracapsular silicone, which presents as high-density material outside the confines of the implant shell, and is diagnostic of extracapsular rupture in patients without prior explantation of silicone implants.

Key Considerations

• Women with implants should follow standard breast cancer screening protocols, as outlined in the ACR Appropriateness Criteria, with modifications to accommodate the implants 1.
• The FDA recommends MRI for evaluating silicone implant rupture in symptomatic patients, but mammography can identify extracapsular silicone and is useful in certain cases 1.
• Implant displacement views (Eklund technique) are used to better visualize the natural breast tissue in women with implants.
• Regular screening is crucial for early detection of breast cancer, as implants do not reduce breast cancer risk.

Recommendations

• Women with breast implants should undergo regular screening mammograms, with modifications to accommodate the implants.
• Technologists should use implant displacement views (Eklund technique) to better visualize the natural breast tissue.
• Women with implants should inform the facility in advance to ensure appropriate scheduling and techniques are used.
• Mammography remains an important screening tool for women with implants, despite potential limitations in interpretation and cancer detection sensitivity.

From the Research

Screening Mammograms in Women with Implants

• Screening mammograms can be performed in women with breast implants, but the technique and image quality criteria may need to be adjusted to accommodate the implant 2.
• The use of implant displacement (ID) views can improve the visibility of breast cancer in women with implants, and ID MLO views alone may be sufficient for MLO projection, reducing the patient's radiation dose without compromising breast cancer detection capability 3.
• Digital mammography with digital breast tomosynthesis (DM/DBT) may improve recall rates, cancer detection rates, and positive predictive values for recall compared to digital mammography alone in women with implants, although the trends are not always statistically significant 4.
• The diagnostic performance of mammography in women with implants may be affected by factors such as breast density, implant type, and patient history, and the use of additional imaging modalities such as ultrasound or MRI may be necessary to improve detection rates 5, 6.

Image Quality Criteria

• The image quality criteria used for standard mammograms may not be applicable to breast implant mammograms due to implant overlap, and further studies are necessary to define the appropriate protocol, technique, and suitable quality criteria for assessing breast implant mammograms 2.
• The alignment of the image with the detector's centre seems to have an impact on the amount of visible tissue, and the placement of the implant (subpectoral/subglandular) or performing the Eklund view can influence the visible anatomy 2.

Comparison of Imaging Modalities

• MRI has been shown to have higher sensitivity and specificity for breast cancer detection compared to mammography and ultrasound, especially in women with dense breast tissue or implants 5, 6.
• The combination of imaging modalities, such as MRI and mammography or ultrasound, can improve diagnostic performance and increase cancer detection rates 6.