10 Things to Know About Breast Cancer Screening With Implants

Breast cancer screening is important if you have implants, and there are a few factors to keep in mind.

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," Jay Baker, MD, chief of the division of breast imaging at Duke University Medical Center in Durham, North Carolina, told Health.

"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.

According to the Susan G Koman Foundation, breast implants are not associated with an increased risk of breast cancer. The American Cancer Society says that breast cancer risk is tied to such factors as being older, being overweight, having a family history of breast cancer, or inheriting certain genetic mutations linked to breast cancer.

Implants are associated with a rare type of blood cancer that is unrelated to breast cancer, though.

National guidelines suggest that most women have screening mammograms annually or every other year beginning between age 40 and 50, whether or not they have implants. One caveat: The National Cancer Institute says a woman who has had an implant after a mastectomy should ask her doctor whether she needs 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 doctor 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," Sameer Patel, MD, associate professor in the department of surgical oncology at Fox Chase Cancer Center in Philadelphia told Health. Talk to your surgeon about how you can tell what is breast tissue and what is implant, Dr. Patel advised.

Results of a study published in the journal Plastic and Reconstructive Surgery in 2018 suggest that breast cancers are likely to be detected at smaller sizes in women with breast implants, 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.

Implants May Reduce Mammography Breast Cancer Detection

According to the American Cancer Society (ACS), 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, the ACS says.

"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 says it's not a common occurrence.

A 2004 study in the Journal of Women's Health 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.

Yet there are almost 200,000 women who undergo breast augmentation each year, says the American Society of Plastic Surgeons.

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.

"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 Poses a Small Risk

If a suspicious area of breast tissue is found, a needle biopsy may be done to extract a cell sample for lab testing. In women with implants, this can be a risky procedure depending on where the lump is located.

"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."

Get Any Lumps Checked

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 urges any woman who feels a lump to get checked out. Don't assume it's the implant and ignore it, Dr. Baker said.

"A woman who has implants is not at increased risk of developing breast cancer," Dr. Baker said, "but it does not prevent her from getting breast cancer."

Implants and a Rare Type of Cancer

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.

The FDA says that BIA-ALCL symptoms include pain, lumps, swelling, or 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 a woman'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.

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