Breast Implants and mammogramsBreast implants are becoming increasingly common. We see implants of all types here at Breast Center of New England: silicone and saline, months old to decades old, in front of the muscle and behind it, ruptured or intact.

Here’s a primer on implants and breast imaging – the kinds of things I tell my friends when they ask. 

The first thing to know is that it is highly, highly unlikely a mammogram will rupture your implants. Implants are made to last years and withstand all sorts of pressure. Older implants are more likely to rupture than newer ones – not from mammograms, but from all causes. That’s because the shell of an implant breaks down over time, and even the newest implants, which are made with decades of scientific and engineering advances to last longer, will give out at some point. In a 2022 plastic surgery journal article, only 35 implant ruptures related to mammography were found out of over 20,500 implant adverse events. That means that less than 0.17% of reported ruptures were thought to have been caused by mammograms.

Next, when you come for your mammogram, the technologist will need to take at least four pictures of each breast, instead of the usual two pictures. That’s because we want to see the breast with the implant as well as without it when the implant is pushed back and out of view. These extra pictures, called implant-displaced or pushback views, are typically part of the examination where 3D (tomosynthesis) technology is used, so they’re important for cancer detection.

There is ongoing debate regarding if or by how much implants can mask breast cancer. Many breast imaging radiologists believe that implants – especially silicone implants – can obscure a significant amount of breast tissue even when pushback views are obtained. This has not translated into a significant number of missed cancers in scientific studies, however, and so the topic remains under investigation.

Finally, it’s important to know how we diagnose an implant rupture. For saline implants, deflation is usually obvious and quick. We’ve had patients who woke up one morning with a deflated implant. There’s no need to do any imaging to investigate the possibility of a ruptured saline implant. Silicone implants, however, are different. There are many women walking around with implants that ruptured “silently” years ago. For women with silicone implants, the FDA now recommends screening for rupture with either MRI or ultrasound beginning five years after implants were placed. Mammograms are typically not used to determine if an implant is ruptured, although they can give helpful clues for women who aren’t routinely undergoing implant evaluation with MRI or ultrasound. 

https://journals.lww.com/annalsplasticsurgery/abstract/2022/09000/breast_implant_related_adverse_events_during.5.aspx

https://academic.oup.com/jbi/article/5/3/360/7148285?login=false

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