Breast augmentation, the No. 1 U.S. cosmetic surgical procedure, is commonplace in Southern California.
Breast implants also may make detecting breast cancer, the second leading cause of cancer deaths in U.S. women, more difficult during routine mammograms.
That is unless the breast center you go to for screening has experience working with implants, says Dr. Freddie J. Combs, breast imaging director at UCI Health Pacific Breast Care Center.
‘We know how to work with them’
“We frequently do mammograms of patients with implants and are comfortable working with them,” Combs says. “They can make cancers harder to see in some cases.”
Sometimes performing mammograms on patients with breast augmentation can be challenging, especially if scar tissue has formed around an implant, making it harder to manipulate.
But Combs and his experienced technicians at the Costa Mesa center, which only does 3D mammography and was recently designated a Breast Imaging Center of Excellence by the American College of Radiology (ACR), have many years of practice.
“It can be harder to see certain areas of the breast that are obscured by implants,” he says. To compensate, breast imagers take additional images to improve visualization of the tissue.
Ultrasound or MRI also may be needed
“We do implant-displaced views where we move it out of the way to get a complete picture.” If further imaging is still needed, Combs says, an ultrasound or MRI can be performed.
Unlike for women with dense breast tissue, Combs says that implants do not increase the risk for developing breast cancer.
“Women who are considering implants should discuss the risks with their doctor and understand that cancers might be harder to see,” he says. “But as far as screening for cancer, the guidelines are the same for women with implants and without.”
What to know about breast cancer screening
Those guidelines have gotten a bit confusing of late.
The American College of Radiology (ACR) and the American Society of Breast Surgeons (ACBS) both recommend annual mammograms starting at age 40 among women at average risk of developing breast cancer. They also recommend that all women be assessed for their breast cancer risk beginning at age 25.
However, the American Cancer Society recommends annual screenings for women of average risk beginning at age 45, and the U.S. Preventive Services Task Force (USPSTF) recommends starting at age 50.
Combs, who follows the ACR guidelines, believes it is important to start screening at age 40 for women of average risk. Women at greater risk should consult with their physicians.
Types of breast screening
The various exams and tests used to identify breast abnormalities and detect cancer are:
- Breast self-exams: Regularly inspect your breasts for any differences in how they look or feel. Although this should not replace screenings, many doctors are in favor of women becoming familiar with their breasts and notifying their providers whenever they identify changes.
- Mammography: A mammogram uses low-dose X-rays to produce images of breast tissue to detect lumps, tumors or other abnormalities. It is used for routine screenings or when problems are suspected.
- Digital mammography: A 3-D mammogram, known as breast tomosynthesis, is an imaging test that combines multiple X-rays to create a three-dimensional picture of the breast to detect lumps, tumors or other abnormalities. It is used for routine screenings or when problems are suspected.
- Ultrasound: An ultrasound may be done to find out if a problem found by a mammogram or physical exam of the breast may be a cyst filled with fluid or a solid tumor. It does not use radiation. Ultrasound is not recommended for routine screening. Although it has been shown to detect more cancers, it has a high false-positive rate.
- MRI (magnetic resonance imaging): MRI uses magnetic fields to create a picture of the breast to detect cancers and other abnormalities. It can be used for women at high risk for breast cancer.
Screening saves lives
Combs stresses the importance of screening for all women.
“The vast majority of women who die from breast cancer weren’t screened — they were either too young or didn’t follow through with screening recommendations.”
When scheduling a mammogram, Combs recommends asking at the outset about the skill level of the radiologists and technicians performing and reading the tests.
If you have implants, he adds, be sure to ask whether the technicians and radiologists have experience taking and reading images of breasts with implants.