Breast Cancer and Breast Implants: Protect Yourself

Cosmetic breast augmentation with implants may make screening for breast cancer a bit more challenging, but this is not an excuse to avoid regular screening. A mammogram (breast X-ray) or magnetic resonance imaging (MRI) can save your life, so follow your doctor's advice regarding breast cancer detection. If you have implants, you may need some extra photos taken during your mammogram, and there is a slight risk of implant rupture, but mammograms are still the best way to detect breast cancer in its early, most treatable stages.

Breast Cancer Screening Through the Ages

Women in their 20s and 30s should have a clinical breast exam by a health professional every three years. After age 40, women should have a clinical breast exam every year. Some groups recommend a monthly breast self-exam.

Women age 40 and older should also have a screening mammogram every year and should continue to do so for as long as they are healthy, according to the American Cancer Society (ACS).

The most recent government guidelines contradict these longstanding ACS recommendations and therefore have become the subject of considerable controversy. The U.S. Preventive Services Task Force (USPSTF) now advises women to get a mammogram every two years starting at age 50. The task force stated that there is more risk than benefit with annual mammograms for women in their 40s.

Importantly, both sets of recommendations are only directed at women who are at average risk for breast cancer.

Breast Cancer: Are You at Risk?

Risk factors for breast cancer include:

• Advancing age
• Personal history of breast cancer
• Family history of breast cancer
• BRCA1 and BRCA2 genes
• Radiation exposure to the chest
• Obesity
• Starting menstruation before age 12
• Beginning menopause after age 55
• Having your first child after age 35
• Use of HRT to combat menopausal symptoms

Mammograms and Your Breast Implants

The recommended screening guidelines for women who have had breast augmentation with breast implants solely for cosmetic reasons are the same as those for women who do not have breast implants. They do not necessarily apply to breast cancer survivors who get breast implants following breast reconstruction. These women may or may not need routine mammograms based on the extent of their surgery. For example, some women who receive an implant after a wide lumpectomy (removal of the tumor) may still need screening. Breast cancer screening should be individually tailored to each woman who has previously had breast cancer surgery. Local recurrence and new breast cancer can both occur in the breast or area of the breast where surgery was performed.

If you have a family history of breast cancer, you should discuss it with your physician before undergoing breast augmentation. He or she may ask you to have a mammogram before your breast augmentation with breast implants to ensure that your breasts are healthy. This will also provide a baseline picture of your breasts. This is important because breast implants can obscure the mammogram images, decreasing the radiologist's ability to identify early breast cancer. Still, mammograms are an effective way to screen for breast cancer in women with breast implants.

More About Mammograms

A mammogram is a breast X-ray. During a mammogram, you will be standing so that your breast is resting on a flat, clear plastic plate. A second plate will be adjusted to compress your breast. The compression keeps the breast from moving and helps create a sharper image. Usually, each breast is X-rayed from two different positions. The films are then sent to a radiologist to be evaluated.

If there is any irregularity seen on your mammogram, the clinic should contact you within two weeks. It is prudent to follow up regardless of the clinic's policy. Make sure to call the clinic within two weeks for your results. Do not assume that no phone call means everything is OK.

If there is an irregularity, you may need follow-up testing such as a breast ultrasound or magnetic resonance imaging (MRI). These additional tests may be followed by a biopsy, in which a surgeon samples a small amount of tissue to see if it is malignant or benign.

Although the guidelines for how often women with implants for cosmetic breast enhancement should have screening mammograms are the same as for women without them, women with breast implants usually have four extra pictures taken during their screening mammogram. These extra images are called implant displacement views or Eklund displacement views.

During these pictures, your implant is pushed back against your chest wall and your breast is pulled forward over it so the radiologist can see the front of each breast. These pictures are easier to take in women whose breast implants are placed under their chest muscle.

Rarely, mammograms can cause an implant to rupture.

Digital or computerized mammography may be better suited than conventional mammography for women with breast implants. These systems employ special computer techniques that allow the radiologist to better visualize the area surrounding the breast implant. Digital mammography is similar to conventional mammography. Instead of X-ray film, however, the system uses detectors that are similar to those used in digital cameras. These detectors convert X-rays into electrical signals, which in turn produce images of the breast that can be seen on a computer screen or printed on special film. Digital mammography may one day become the standard for diagnosing breast cancer.

If you have breast implants, protect your breast health and the integrity of your implants by:

• Getting mammograms regularly
• Choosing a facility that sees many women with breast implants (Ask your surgeon which facility he or she recommends)
• Telling the staff at the imaging facility that you have breast implants when you make your appointment and again at the time of your mammogram

Breast Implants and Magnetic Resonance Imaging

If you have silicone breast implants, you will need to have an MRI of your breasts three years postoperatively, then every two years, to check for ruptures. If a silicone implant ruptures, it is not immediately evident because the silicone gel leaks out slowly.