Can patients with breast implants have mammograms?

Mammography in Patients with Breast Implants

Yes, patients with breast implants can and should have mammograms following the same breast cancer screening protocols as patients without implants, with the addition of specialized implant-displaced views to maximize breast tissue visualization. 1

Screening Recommendations

Patients with breast implants must follow standard breast cancer screening guidelines based on age, with no exemption or modification to screening intervals due to implant presence. 2, 1

• Female and transfeminine patients with implants should adhere to the same breast cancer screening protocols outlined by the American College of Radiology for patients without implants 2
• The presence of implants does not eliminate the need for routine mammographic screening 1, 3

Required Mammographic Technique

Both standard views AND implant-displaced (Eklund) views must be obtained during mammography to adequately visualize breast tissue. 1

• Standard craniocaudal and mediolateral oblique views are performed first 2
• Implant-displaced views are then obtained by pushing the implant posteriorly against the chest wall while pulling breast tissue forward for compression 1
• This dual-technique approach maximizes visualization of breast tissue that would otherwise be obscured by the radiopaque implant 1

Age-Specific Imaging Protocols

Patients Under 30 Years

• Ultrasound is the examination of choice for suspected implant complications 1, 4
• Diagnostic mammography is typically not performed as the initial imaging study in this age group 2

Patients 30-39 Years

• Either mammography/digital breast tomosynthesis (DBT) or ultrasound may be used first for suspected complications 1, 4
• Ultrasound may be complementary to diagnostic mammography or DBT 2

Patients 40 Years and Older

• Mammography or DBT is the first-line examination for both screening and evaluation of suspected implant complications 1, 4
• Ultrasound may be used as complementary imaging or as an alternative if the patient is unable to undergo mammography 2

Limitations and Important Caveats

Mammography has significant limitations in detecting implant-specific complications, particularly intracapsular silicone implant rupture. 2, 1

• Silicone implants appear extremely radiopaque on mammography, preventing internal substructural evaluation 2
• Mammography cannot reliably detect intracapsular rupture, which represents the majority of implant ruptures 1, 4
• Mammography can identify extracapsular silicone when high-density silicone is visible outside the implant contour 2
• The sensitivity of mammography for detecting implant rupture is low due to the extreme radiopacity of silicone 2

Impact on Breast Cancer Detection

While implants reduce mammographic sensitivity, they do not appear to adversely affect breast cancer stage at diagnosis or patient survival. 5

• Augmented patients present more frequently with palpable lesions and false-negative mammograms compared to non-augmented patients 5
• Despite diminished mammographic sensitivity, augmented and non-augmented patients are diagnosed at similar stages of disease with comparable prognosis 5
• Implants may facilitate tumor detection on physical examination, potentially offsetting the reduced mammographic sensitivity 5

Risk of Implant Rupture During Mammography

Implant rupture during mammography is a documented but relatively uncommon adverse event. 6

• Among adverse event reports to the FDA, 62.1% of mammography-related complications involved breast implant rupture during the procedure 6
• Other reported complications include pain during mammography, inability to perform mammography due to capsular contracture, and delayed cancer detection 6
• Patients should be informed of this potential risk preoperatively 3, 6

Implant Type Considerations

Saline Implants

• Rupture is usually clinically evident, with patients experiencing change in breast size and shape over days as saline is resorbed 2, 4
• A collapsed implant shell may be visible on mammography when rupture occurs 2
• Diagnostic mammography may be useful when clinical findings are equivocal 2

Silicone Implants

• Rupture is more difficult to detect clinically, with clinical examination being unreliable 2, 1, 4
• Silicone implants appear oval, smooth, and uniformly dense on mammography 2
• Close inspection of implant contour is critical, with comparison to prior mammograms useful for identifying subtle changes such as undulations that may indicate compromised integrity 2
• Frank bulges or herniations represent areas of weakening and potential rupture points 2

Surveillance for Implant Integrity

For asymptomatic patients with silicone implants, dedicated implant surveillance imaging (MRI or ultrasound) should begin at 5-6 years postoperatively, then every 2-3 years thereafter—this is separate from routine breast cancer screening mammography. 1, 3

• This surveillance is specifically for detecting implant rupture, not for breast cancer screening 1
• MRI without contrast is the definitive imaging modality for silicone implant rupture evaluation 4
• Some experts recommend ultrasound as the initial screening tool for women under 40, with MRI reserved for abnormal sonographic findings 1

Clinical Practice Pearls

• Comparison with prior mammograms is essential for identifying subtle contour changes over time 2, 1, 7
• Capsular calcifications correlate with implant age but do not indicate rupture 4, 7
• An implant becoming more rounded may signify capsular contracture rather than implant integrity problems 2, 7
• Clinical examination alone is unreliable for detecting implant rupture and should not be used as the sole diagnostic method 1, 4, 7