What type of mammogram is recommended for a woman with breast implants?

Mammography for Women with Breast Implants

Women with breast implants should undergo standard mammography (or digital breast tomosynthesis) using BOTH standard compression views AND implant-displaced (Eklund) views to maximize breast tissue visualization, following the same screening schedule as women without implants. 1

Screening Protocol by Age

The American College of Radiology recommends that patients with breast implants follow identical breast cancer screening protocols as those without implants, with critical technical modifications 1:

For Women Age 40 and Older

• Mammography or digital breast tomosynthesis (DBT) is the first-line screening modality 2, 1
• Both standard craniocaudal and mediolateral oblique views PLUS implant-displaced views must be obtained at every screening 1
• This dual-view approach is non-negotiable for adequate breast tissue evaluation 1

For Women Age 30-39

• Mammography or DBT is appropriate for screening 2
• Same dual-view technique (standard + implant-displaced) applies 1

For Women Under Age 30

• Screening mammography is generally not indicated unless there are specific risk factors 2

Critical Technical Requirements

The implant-displaced (Eklund) technique is essential and must be performed in addition to standard views 1, 3:

• Standard compression views alone result in 25-44% decrease in visualized breast tissue depending on implant position 4
• Implant-displaced views push the implant back against the chest wall while pulling breast tissue forward 3, 5
• Anterior breast tissue is better visualized with displacement views, while posterior tissue is better seen with standard compression 4

What Mammography Can and Cannot Detect

Mammography in women with implants can detect breast cancer in visualized tissue and extracapsular silicone rupture, but cannot reliably detect intracapsular implant rupture 1, 6:

• Sensitivity for detecting breast abnormalities: 73% 2
• Extracapsular silicone appears as high-density material outside the implant shell 6
• Intracapsular rupture (the majority of implant ruptures) requires MRI for diagnosis 1, 6

Important Clinical Caveats

Always compare with prior mammograms, especially in patients with previous silicone implants 1:

• Residual silicone from previously removed implants can mimic new extracapsular rupture 1
• Capsular calcifications correlate with implant age but do not indicate rupture 6

Image quality is inherently compromised by implants 4, 7:

• Subglandular implants reduce measurable tissue area by 44% with compression and 36% with displacement technique 4
• Submuscular implants reduce measurable tissue area by 25% with compression and 15% with displacement technique 4
• Despite these limitations, screening remains essential and follows the same schedule 1

Implant Evaluation vs. Cancer Screening

For asymptomatic women with breast implants, no additional imaging is recommended specifically for implant evaluation 2, 1:

• Mammography is performed for cancer screening, not routine implant surveillance 1
• Saline implant rupture is clinically evident (breast size/shape change) and does not require imaging surveillance 2, 1
• Silicone implant integrity monitoring requires MRI or ultrasound starting at 5-6 years post-surgery, then every 2-3 years, but this is separate from cancer screening 1

Common Pitfalls to Avoid

• Never perform mammography without implant-displaced views - this results in inadequate breast tissue visualization 1, 4
• Do not skip screening because of implants - cancer screening protocols remain unchanged 1
• Do not rely on mammography alone to evaluate suspected implant rupture - MRI without contrast is required for silicone implant integrity assessment 6, 8