Can a patient with breast implants undergo regular mammography (mammo)?

Mammography in Patients with Breast Implants

Yes, patients with breast implants can and should undergo regular mammography for breast cancer screening following the same protocols as patients without implants, but with specialized imaging techniques that include both standard views and implant-displaced views. 1, 2

Breast Cancer Screening Protocol

Patients with breast implants follow identical breast cancer screening guidelines as those without implants, with the critical addition of specialized mammographic techniques to maximize breast tissue visualization. 1, 2

Required Mammographic Views

• Both standard craniocaudal (CC) and mediolateral oblique (MLO) views PLUS implant-displaced (ID) views must be obtained during mammography to adequately visualize breast tissue around the implant. 2
• The implant-displaced views (also called Eklund views) push the implant back against the chest wall while pulling breast tissue forward, allowing better visualization of anterior breast tissue. 2, 3
• Standard views provide better visualization of posterior breast tissue and proper breast positioning, while ID views significantly improve cancer visibility, particularly in dense breasts with subpectoral implants. 3

Age-Based Screening Recommendations

The American College of Radiology provides clear age-stratified guidance:

• Patients 40 years and older: Mammography or digital breast tomosynthesis (DBT) is the first-line screening examination. 1, 2
• Patients 30-39 years: Either mammography/DBT or ultrasound may be used as initial screening. 1, 2
• Patients under 30 years: Ultrasound is the examination of choice if imaging is needed for suspected complications. 1, 2

Critical Distinction: Screening vs. Implant Evaluation

For asymptomatic patients with breast implants, imaging is NOT recommended specifically for implant evaluation alone—only for breast cancer screening per standard protocols. 1, 2

Implant-Specific Monitoring (Separate from Cancer Screening)

• Silicone implants: Require dedicated rupture surveillance with MRI or ultrasound starting at 5-6 years post-surgery, then every 2-3 years thereafter. 2, 4, 5
• Saline implants: No routine imaging for implant integrity is needed, as rupture is clinically evident (breast size/shape change). 1

Important Limitations and Caveats

Reduced Tissue Visualization

• Breast implants obscure breast tissue on mammography, with subglandular implants reducing visualized tissue area by approximately 44% on standard compression views and 36% on displacement views. 6
• Submuscular implants cause less tissue obscuration (25% reduction on compression, 15% on displacement views). 6
• Despite reduced visualization, mammography remains the standard screening modality and should not be withheld. 2, 5

Image Quality Considerations

• Most patients experience some degree of parenchymal scarring and lower overall image quality after augmentation. 6
• Standard views show higher radiation exposure (higher kVp, mAs, compressed breast thickness) compared to ID views, though organ dose differences are not statistically significant. 3

Common Pitfalls to Avoid

• Do not skip mammography in patients with implants—they require the same breast cancer screening as the general population. 1, 2
• Do not confuse breast cancer screening with implant integrity monitoring—these are separate protocols with different imaging modalities and schedules. 2, 4
• Do not rely on standard views alone—implant-displaced views are essential for adequate breast tissue evaluation. 2, 3
• Do not assume implants increase breast cancer risk—no association exists between implants and increased cancer incidence. 7