Can a woman with breast implants undergo mammography?

Can Women with Breast Implants Undergo Mammography?

Yes, women with breast implants can and should undergo mammography for breast cancer screening following the same protocols as women without implants, with the critical addition of specialized implant-displaced views. 1, 2

Screening Mammography Protocol for Implant Patients

Women with breast implants must follow standard breast cancer screening guidelines based on age, but with modified technique 1, 2:

• Both standard views (craniocaudal and mediolateral oblique) AND implant-displaced views must be obtained during every screening mammogram to maximize visualization of breast tissue 1, 2
• The implant-displaced technique (Eklund views) pushes the implant back against the chest wall while pulling breast tissue forward, allowing better tissue evaluation 3
• Age 40 and older: Screening mammography or digital breast tomosynthesis (3D mammography) is the first-line screening modality 1, 2
• Under age 40: Follow standard screening guidelines; implants do not change the age to begin screening 1, 2

What Mammography Can and Cannot Detect in Implant Patients

Mammography CAN detect:

• Breast cancers in visualized tissue 2, 4
• Extracapsular silicone rupture (when silicone escapes outside the fibrous capsule) 1
• Collapsed saline implant shells 1
• Contour changes suggesting implant complications 1

Mammography CANNOT reliably detect:

• Intracapsular silicone implant rupture (rupture contained within the fibrous capsule) - this is the most common type of silicone rupture 1, 2
• Internal implant structural problems due to the extreme radiopacity of silicone 1

Evidence on Screening Effectiveness

Research demonstrates that breast implants do not significantly impair cancer detection when proper technique is used 4, 5:

• A large screening program study of 45,134 examinations found no statistically significant difference in recall rates between women with implants (5%) versus those without (7%) 4
• Women with implants had similar cancer detection rates and outcomes compared to women without implants 4, 5
• There is no evidence that women with implants have later-stage diagnosis or poorer prognosis when breast cancer is detected 6

Critical Technical Considerations

Always compare with prior mammograms, especially in patients with previous silicone implants, to differentiate new extracapsular rupture from residual silicone from previously removed implants 1, 2, 7

Age-Specific Diagnostic Approach for Suspected Complications:

• Under 30 years: Ultrasound is the initial examination of choice for suspected implant complications 1, 8
• 30-39 years: Either mammography/DBT or ultrasound may be used first 1, 8
• 40 years and older: Mammography or DBT is first-line for both screening and evaluation of suspected complications 1, 2, 8

Common Pitfalls to Avoid

• Do not rely on clinical examination alone to detect implant rupture or breast abnormalities - clinical examination is unreliable for detecting implant complications 1, 2, 8
• Do not skip implant-displaced views - standard views alone may miss up to 55% of breast tissue obscured by the implant 3
• Do not assume capsular calcifications indicate rupture - these correlate with implant age but do not necessarily indicate contracture or rupture 1, 7
• Do not use mammography to screen for silicone implant integrity in asymptomatic patients - MRI or ultrasound at 5-6 years post-implantation is recommended for rupture surveillance 1, 2, 8

Implant Type Considerations

Saline Implants:

• Rupture is usually clinically evident with change in breast size and shape over days as saline is resorbed 1
• Mammography can visualize collapsed implant shells 1
• No routine imaging needed for implant evaluation in asymptomatic patients 1, 2

Silicone Implants:

• Rupture is not clinically evident and requires imaging for detection 1, 8
• Mammography has low sensitivity for detecting rupture due to extreme radiopacity 1
• MRI without contrast is the definitive modality for silicone rupture evaluation (sensitivity 87%, specificity 89.9%) 8
• Asymptomatic patients should undergo surveillance imaging (ultrasound or MRI) starting at 5-6 years post-surgery, then every 2-3 years 2, 8, 9

Bottom Line for Clinical Practice

Women with breast implants should not be excluded from mammography screening programs 4. They require the same screening schedule as women without implants, with the mandatory addition of implant-displaced views to ensure adequate breast tissue visualization 1, 2. The presence of implants does not justify delaying or avoiding mammography, as proper technique allows effective cancer detection with outcomes comparable to women without implants 4, 6, 5.