Mammography Safety for Patients with Breast Implants
Mammography is safe and appropriate for patients with breast implants, though special imaging techniques are required to maximize breast tissue visualization. 1, 2
General Recommendations for Breast Implant Imaging
- Patients with breast implants should follow the same breast cancer screening protocols as those without implants, with additional specialized imaging techniques to account for the presence of implants 2
- Both standard craniocaudal and mediolateral oblique views AND implant-displaced views should be obtained during mammography to maximize visualization of breast tissue 2
- For asymptomatic patients with breast implants (any age), imaging is not specifically recommended for implant evaluation alone 1, 3
Age-Specific Recommendations
- For patients under 30 years with suspected implant complications, ultrasound is the examination of choice 1
- For patients 30-39 years with suspected implant complications, either mammography/digital breast tomosynthesis or ultrasound may be used first 1
- For patients 40 years and older, mammography or digital breast tomosynthesis is the first-line examination for both screening and evaluation of suspected implant complications 1, 2
Special Considerations
Implant Type Considerations
- Saline implant rupture is generally clinically evident as the saline is resorbed by the body over days, resulting in a change in breast size and shape 1
- Silicone implant rupture is more difficult to detect clinically and may require specialized imaging 1
- Mammography can identify extracapsular silicone but cannot reliably detect intracapsular rupture 2
Imaging Limitations
- The presence of implants may challenge interpretation of mammography, though there is no evidence this leads to later stage diagnosis or poorer prognosis 4
- Several studies have shown that implants do not significantly affect mammogram results or cancer detection rates 5, 6
- Comparison with prior imaging is critical, especially in patients who have had previous silicone implants 2
Common Pitfalls and Caveats
- Clinical examination alone is unreliable for detecting implant rupture 2, 7
- Mammography cannot reliably detect intracapsular rupture, which represents the majority of implant ruptures 2
- Women with unilateral breast swelling should be evaluated with ultrasonography for an effusion that might indicate breast implant-associated anaplastic large cell lymphoma 8
- There is no scientific reason to exclude women with breast implants from dedicated screening programs 5
Monitoring Protocol for Implant Integrity
- 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 8
- For asymptomatic women with silicone implants under age 40, some experts recommend ultrasound as the initial screening tool, with MRI reserved for patients with abnormal sonographic findings 2