Breast cancer screenings are a critical part of women’s health, with the Centers for Disease Control (CDC) recommending that women who are 40-74 years old and at average risk for breast cancer get a mammogram (which images the breast tissue using X-rays from multiple views) every two years. But when you have breast implants, are all methods of screening created equal? Ahead, we break down what you need to know about mammograms with breast implants and when your doctor might recommend an MRI instead.
Featured Experts
- Mark Jewell, MD is a board-certified plastic surgeon in Eugene, OR
- Bradley Bengtson, MD is a board-certified plastic surgeon in Grand Rapids, MI
- Caroline Glicksman, MD is a board-certified plastic surgeon in Wall Township, NJ
- Bradley Calobrace, MD is a board-certified plastic surgeon in Louisville, KY
Do breast implants make it harder to screen for cancer?
“Most, if not all, of our plastic surgery literature shows that in the absence of capsular contracture or excessive scar tissue around an implant, with additional compression views, patients with implants do not have more breast cancers, more missed breast cancers or larger breast cancers at diagnosis,” explains Grand Rapids, MI plastic surgeon Bradley Bengtson, MD.
Those additional views Dr. Bengtson mentions are the key to keeping breast implants from interfering with breast cancer screenings.
“When you have breast implants, your doctor will want to get an additional X-ray view during a mammogram,” explains Wall Township, NJ plastic surgeon Caroline Glicksman, MD. “This is called the Eklund view, where the implant is pushed back slightly to deliver an unobstructed view of the breast tissue.”
According to Eugene, OR plastic surgeon Mark Jewell, MD, this type of mammogram, while the gold standard in breast cancer screenings, can be uncomfortable for women. “The problem with how it is performed on women with implants is that the Eklund displacement technique squeezes the breast tissue off the implant. It is painful and can even cause implants to rupture.”
Does implant position matter?
Dr. Glicksman points out that our current methods of getting a full view during mammograms may not be totally functional options if the implant is pre-pectoral, or in front of the pectoral muscle. “There may be more concerns regarding cancer screenings when these patients who are in their 20s now get to be 40 or so,” she explains. “I would say that the pocket location matters. When the implant is behind the muscle or dual-plane, a radiologist can see essentially all of the breast tissue, and there may need to be alterations made to mammogram protocol to get an accurate picture of the breast if the implant is in front of the muscle.”
Is an MRI better than other screening methods?
“An MRI is excellent, but expensive,” Dr. Jewell says. “It works for cancer detection and to determine implant integrity, but is not accessible to most women.”
And for patients, there is also concern about the amount of radiation an MRI delivers.
“For over 15 years, the FDA recommended an MRI three years after implant placement and every two years after that,” explains Louisville, KY plastic surgeon Bradley Calobrace, MD. “This was for implant surveillance, not cancer screening. However, almost no women ever followed that recommendation as it delivers a lot of radiation over the years and has a large expense.”
For these reasons, Dr. Bengtson and Dr. Calobrace both note that many practitioners use ultrasounds to monitor implants rather than an MRI.
When might an MRI be the right choice?
“If there is a personal or familial history of breast cancer, an MRI may be the best option,” explains Dr. Jewell.
But that may not be enough to get an MRI covered by insurance plans.
“Even if you and your doctor push for an MRI, it’s not necessarily likely that insurance will cover that screening,” Dr. Glicksman says. “And as a personal expense, they are prohibitively expensive. Not to mention they’re long, uncomfortable and often not an option for women who have medical devices.”
Ultimately, the best method for screening for breast cancer will be what gives your radiologist the clearest picture of your breast tissue. If issues like scar tissue or implant position make that process difficult, alternatives to mammograms, like an MRI, might be necessary.
