8 Things to Know About Breast Cancer Screening With Implants

When you have breast implants, routine breast cancer screenings require special attention. "It is not as simple as putting in the implants and you're done," said Jay Baker, MD, chief of the division of breast imaging at Duke University Medical Center in Durham, North Carolina.

"Downstream issues, like how implants affect regular screening mammograms, often aren't discussed in as much detail as they should be when a woman has implant surgery," Dr. Baker explained.

Breast implants are not associated with an increased risk of breast cancer. Breast cancer risk is tied to such factors like age, being overweight, having a family history of breast cancer, or inheriting certain genetic mutations linked to breast cancer.

However, the US Food & Drug Administration (FDA) has found that, if you have breast implants, you are at an increased risk of developing a rare type of lymphoma called breast implant-associated anaplastic large cell lymphoma (BIA-ALCL).

You should have breast cancer screenings, called mammograms, annually or every other year beginning around the age of 40, whether or not you have implants. As of May 2023, the U.S. Preventative Services Task Force (USPSTF) recommends that cisgender women and people assigned female at birth get mammograms every two years beginning at age 40.

One caveat: If you've had an implant after a mastectomy, you should ask your healthcare provider whether you need a mammogram of the reconstructed breast.

Have implants or thinking of getting them? These facts and tips may help you navigate your regular breast cancer screenings and any related diagnostic testing that your healthcare provider recommends.

Know How Your Implants Feel

If you've had breast augmentation or reconstruction, get to know your new normal.

"We do recommend that if a patient has an implant in place that she become familiar with the implant," said Sameer Patel, MD, associate professor in the department of surgical oncology at Fox Chase Cancer Center in Philadelphia. Talk to your surgeon about how you can tell what is breast tissue and what is implant, Dr. Patel advised.

Research from the Plastic and Reconstructive Surgery journal says that breast cancer is more likely to be detected at smaller implant sizes, especially palpable lumps found by self-examination or during a clinical breast exam. The study involved 48 women who developed breast cancer after implants and 302 women with breast cancer but without implants.

Sometimes women with implants think they detect a lump in their breast, but what they're actually feeling is the implant.

Saline implants, in particular, can bulge like a partially filled water balloon, Dr. Baker pointed out. But Dr. Baker urged that any woman who feels a lump should get it checked out. Don't assume it's the implant and ignore it, Dr. Baker said.

Implants May Reduce Mammography Breast Cancer Detection

Mammograms don't sufficiently penetrate saline or silicone. So, depending on where a cancer is located, it can be tougher to find on a mammogram. "It is manageable; we do it all the time, [but] it definitely makes things a little trickier," Dr. Baker explained.

The Plastic and Reconstructive Surgery research article says that the rate of cancer detection by screening mammography was lower for women with implants (77.8%) versus women without implants (90.7%).

Despite the limitations of mammography screening in women with implants, Dr. Patel said "The outcome in patients that do develop breast cancer, even with implants, is the same as those without implants."

Inform the Mammography Team About Your Implants

If you have implants, tell the scheduler when you make an appointment for your mammogram. Ask if the staff has experience screening women with implants. And give the mammogram tech a heads-up before your imaging procedure begins.

"The technologist needs to know two things. One is how to position the patient. The other is how much compression to use," said Dr. Baker.

An experienced technologist will know how to carefully compress the breasts of women with implants without risking rupture.

Extra Images Might Be Needed

The standard mammogram is two views of each breast—a total of four pictures. But women with breast implants typically require a couple of additional views of each breast. The extra views are gathered to detect cancers that might be obscured by the implants.

"They're called implant displacement views," said Dr. Patel, a member of the National Comprehensive Cancer Network's Guidelines Panel for Breast Cancer.

The breast is drawn out, pushing the implant toward the chest wall "so more of the breast tissue is visualized with the mammogram," Dr. Patel explained.

Implant displacement views involve relatively little compression, "just enough to keep the breast still," Dr. Baker noted.

Implant Rupture With Mammography Is Rare

Worried that your implant might burst under compression? A 2022 review article in the Annals of Plastic Surgery journal says it's not a common occurrence.

Another study examined problems with mammography for women with breast implants. When researchers reviewed adverse events reported to the U.S. Food and Drug Administration (FDA), they identified just 44 incidents involving breast implant rupture with mammography.

In a separate review of published studies, FDA researchers identified another 17 cases involving breast implant rupture during compression.

There are almost 200,000 women who undergo breast augmentation each year. In many rupture cases, Dr. Baker suggested that the implant could have been already compromised "and the compression just helped it along."

Other Types of Screening May Be Necessary

Mammography remains the tool of choice for breast cancer screening. But sometimes, healthcare providers recommend additional imaging.

Ultrasound

"Usually we only do ultrasound screening for women who are high risk [of breast cancer] or women who have dense breast tissue," Dr. Baker explained. But if the radiologist has trouble seeing breast tissue because of implants, "a screening ultrasound is a consideration," said Dr. Baker.

Ultrasound is not a substitute for mammography, Dr. Baker added, because each yields different information. Mammography picks up tiny calcium deposits that can be a precursor to breast cancer, while ultrasound does not. Ultrasound may reveal a small mass hidden by the implant that mammography cannot detect.

Needle Biopsy

If a suspicious area of breast tissue is found, a needle biopsy may be done to extract a cell sample for lab testing. "I always tell patients if there is a needle and an implant in the same breast, there's at least some chance of causing an implant rupture," Dr. Baker said. "It is rare," Dr. Baker added, "but it is absolutely possible."

Risk for Lymphoma

Women with implants are at risk of developing a rare type of lymphoma called breast implant-associated anaplastic large cell lymphoma, or BIA-ALCL. As of April 2022, the FDA said it had received 1,130 reports of this cancer, including 59 patient deaths.

The FDA has continued conducting a review of implant safety concerns. In March 2019, an advisory panel held a two-day hearing on the benefits and risks of the implants. The agency also issued warning letters to two implant makers for failing to conduct long-term safety studies.

Symptoms of BIA-ALCL include:

• Pain
• Lumps
• Swelling
• Redness
• Breast asymmetry

Treatment usually involves removing the implants and surrounding tissue. Sometimes chemotherapy and radiation are required.

Implant Complications May Necessitate Removal

Should you remove your implants if you are diagnosed with breast cancer? That's an individual decision based on each person's cancer and recommended treatment.

A research article published in the July 2022 issue of the journal Plastic and Reconstructive Surgery explained that women with implants who undergo radiation for breast cancer are at increased risk of developing something called capsular contracture. Radiation causes the fibrous tissue that develops around the implant to become hard, tight, and painful.

"In more extreme cases, it can actually affect the physical appearance of the breast where it can deform the breast shape and can actually be visible through the skin," Dr. Patel said.

But there's no need to remove implants just for mammograms. "I would never recommend that a woman remove her perfectly functioning, intact implants to improve her screening," Dr. Baker said.

A Quick Review

Breast implants can impact breast cancer screening in different ways. But, there are ways to work around it. If you are due for a mammogram and you have breast implants, keep in mind that you should seek out an experienced mammography team and always talk to your healthcare provider regarding any concerns you may have.