Common breast cancer screenings require special care when placing breast implants. “It’s not as simple as putting the implants in and you’re done.” Jay Baker, MDsaid the chief of breast imaging at Duke University Medical Center Health.
“The issues that follow, such as how implants affect routine screening mammograms, are often not discussed in as much detail as they should be when a woman undergoes implant surgery,” Dr. Baker said.
Experts advise breast cancer screenings, called mammograms, annually or every other year starting around age 40, regardless of whether you have implants or not. The US Preventive Services Task Force (USPSTF) advises that women and people assigned female at birth have mammograms every two years starting at age 40. Ask a health care provider if you need a mammogram if you’ve had an implant after a mastectomy.
Do you have implants or are you thinking about having them removed? These facts and tips may help you navigate your regular breast cancer screenings and any related testing your healthcare provider recommends.
Know your new normal if you’ve had breast augmentation or reconstruction. “We recommend that if a patient has an implant in place, she familiarizes herself with the implant.” Sameer Patel, MDsaid associate professor in the division of surgical oncology at Fox Chase Cancer Center Health.
Talk to a surgeon about how you can tell what is breast tissue and what is an implant. People with implants may think they are sensing a lump in their breast, but what they are actually feeling is the implant. Saline implants, in particular, can swell like a partially filled water balloon.
Research has shown that breast cancer is more likely to be detected in smaller implant sizes, especially palpable lumps found by self-exams or clinical breast exams. Dr. Baker urged anyone who feels a lump to get it checked out. Don’t assume a lump is the breast implant or ignore it.
Mammograms do not adequately penetrate serum or silicone. It may be more difficult to find on a mammogram, depending on where the cancer is located. “It’s manageable; we do it all the time, [but] it definitely makes things a little more difficult,” Dr. Baker said.
Research has shown that the cancer detection rate with preventive mammography is 77.8% for women with implants. This percentage is lower than that of women without implants, which is 90.7%.
“The outcome in patients who develop breast cancer, even with implants, is the same as those without implants,” despite the limitations of mammography screening in people with implants, said Dr.
When you make a mammogram appointment, tell the scheduler that you have implants. Ask if the staff has experience examining people with implants. Notify the mammography technologist before the imaging procedure begins.
“The technologist has to know two things. One is how to position the patient. The other is how much compression to use,” Dr. Baker said. An experienced technologist will know how to carefully compress the breasts without risking rupture.
A typical mammogram includes two views of each breast for a total of four images. People with breast implants usually require a few additional views of each breast. The extra screenings are collected to detect cancers that may be hidden by the implants.
“They’re called implant displacement facets,” Dr. Patel said. The breast is pulled outward, pushing the implant against the chest wall “so more of the breast tissue is visible on the mammogram.”
Implant displacement facets involve relatively little compression. A health care provider uses “just enough to keep the breast still,” Dr. Baker said.
Worried that your implant might pop under pressure? Research has shown that rupture is not a common occurrence. The Food and Drug Administration (FDA) has identified 17 cases involving breast implant rupture during compression.
There are nearly 200,000 women who undergo breast augmentation each year. The implant could have already been compromised, “and the compression just helped it,” Dr. Baker said.
Mammography remains the tool of choice for breast cancer screening. Your healthcare providers may recommend additional imaging if you have implants.
Ultrasound
“Usually, we only do ultrasound screening for high-risk women [of breast cancer] or women who have dense breast tissue,” Dr. Baker said. “A screening ultrasound is a test” if the radiologist has trouble seeing breast tissue because of implants.
Ultrasound is not a substitute for mammography because each gives different information. A mammogram picks up tiny calcium deposits that can be a precursor to breast cancer, but an ultrasound does not. Ultrasound can reveal a small mass hidden by the implant that mammography cannot detect.
Needle biopsy
A needle biopsy may be done to extract a sample of cells for laboratory testing if a suspicious area of breast tissue is found. “I always tell patients if there is a needle and an implant in the same breast, there is at least some chance of an implant rupture,” Dr. Baker said. “It’s rare, but it’s absolutely possible.”
Breast implants are generally not associated with an increased risk of breast cancer. The risk of breast cancer is linked to factors such as age, being overweight, a family history of the disease or the inheritance of certain genetic mutations.
The FDA has found that breast implants can increase the risk of a rare type of lymphoma. This type of lymphoma is called breast implant-associated anaplastic large cell lymphoma (BIA-ALCL).
Symptoms of BIA-ALCL include:
- Breast asymmetry
- Lumps
- Pain
- Redness
- Swelling
Treatment usually involves removing the implants and surrounding tissue. A health care provider may advise chemotherapy and radiation therapy in some cases.
The FDA said it has received 1,264 reports of this cancer, including 62 deaths, through 2023. In 2019, an advisory panel held a two-day hearing on the benefits and risks of implants. The FDA also issued warning letters to two implant manufacturers for failing to conduct long-term safety studies.
Whether you should have your implants removed if you are diagnosed with breast cancer is an individual decision. It is important to talk to a health care provider about the type of cancer you have and the treatment they recommend.
A study published in 2022 found that women with implants undergoing radiation therapy for breast cancer are at increased risk of capsular contracture. Radiation therapy causes the fibrous tissue that grows around the implant to become hard, tight, and painful.
“In more extreme cases, it can actually affect the natural appearance of the breast, where it can distort the shape of the breast and be visible through the skin,” Dr. Patel said.
You don’t need to have implants removed just for a mammogram. “I would never recommend that a woman remove her perfectly functioning, intact implants to improve screening,” Dr. Baker said.
Breast implants can affect breast cancer screening in several ways. You may need to become more familiar with your implants so that you can properly detect the bumps. You may also need additional testing such as an ultrasound or needle biopsy.
Look for an experienced mammography team if you are going to have a mammogram and breast implants. In some cases, complications may require breast implant removal. Always talk to a healthcare provider about any concerns you may have.