Dear Dr. Reichman: I'm 40 and I know that I need to begin to have annual mammograms. I had breast implants six years ago, and now I’m worried. Can the mammogram procedure rupture the implants? And can my implants obscure signs of breast cancer? — Busty and bothered
Dear Busty: You have two valid concerns. Breast augmentation is the second most frequent surgery performed by plastic surgeons. It's estimated that over 4 million women have had this surgery, approximately 80 percent for cosmetic reasons and 20 percent for reconstruction after mastectomy. Breast cancer will affect 12.5 percent or 1 out of 8 women in their lifetime. As breast cancer incidence peaks (between the ages of 50 and 69) women who have had augmentation will be faced by the same concern —can breast cancer be found if you have an implant?
Recent studies of over 36,000 women with implants compared the observed rate of diagnosed breast cancer in these women with that expected in the general population. Paradoxically, it was found that the breast cancer incidence in women with augmentation not only did not increase, but was somewhat lower than that seen in the general population. The reason this is somewhat surprising is that implants can cause a 15 to 50 percent decrease in the mammographically visualized breast tissue and several studies have reported false negative mammograms (those that missed the cancer) in 12 to 67 percent of women with augmentation.
The latter numbers are hardly reassuring, but it's possible (though many feel not medically probable) that breast implants may decrease breast cancer incidence by:
- Compressing breast tissue and interfering with its blood supply
- Decreasing temperature in the breast
- Stimulating an immunological response which helps destroy potential breast cancer cells.
It may just be, however, that the apparent decreased incidence of breast cancer in women with breast implants reflects the fact that these women are more likely to be thin. (Obesity is a significant risk factor for breast cancer.) Also, the women with breast implants tend to be in a higher socioeconomic group with better nutrition, exercise, cancer screening, and access to medical care.
Having given you this reassurance let me point out that in order to properly visualize an augmented breast, the breast should be compressed in a special fashion that may require 4 separate views. And if biopsy is required, you’ll need to have an open biopsy so that the implant is not punctured. Otherwise, you could have an ultrasound-guided needle biopsy or a stereotactic biopsy.
If cancer is found, the implants, especially if placed above the chest muscles, make it difficult to treat with “just” a lumpectomy and radiation. It can be difficult to achieve a cancer free surgical margin while preserving the implant. Radiation may also cause the implant to harden and contract.
Let me address your concern that a mammogram could “hurt” your implants. There were only 41 cases of implant ruptures during mammography reported to the U.S. Food and Drug Administration between June 1992 and October 2002. Another 17 cases related to mammograms have been reported in the medical literature. This occurrence is obviously quite rare, so implants should not be a disincentive to getting your mammogram.
Finally, some of my patients ask if ultrasound, which is a softer, gentler procedure, can be used to screen for cancer in lieu of a mammogram. My answer is no. Ultrasound doesn’t pick up the minute calcifications that are the hallmark of early breast cancer and its results vary tremendously based on who is performing and viewing the image. Ultrasound as an adjunct test used to distinguish between solid and cystic masses or to help assess very dense breasts, but it should not be the primary screening tool to detect breast cancer.
An MRI can be used to detect a silent rupture in a silicone implant, but routine use for breast cancer detection is limited to high risk women (those who have a strong genetic history, are known to have BRCA mutations or who had had previous diagnosed breast cancer). This may become “the test of the future” but currently it’s very expensive and has a high rate of false positive results (findings that require a biopsy but turn out to be benign).
Dr. Reichman’s Bottom Line: You’ve already manifested breast concerns by having an augmentation procedure. Your implants do not increase your risk of breast cancer. Don’t raise your risk of a delayed diagnosis by letting your implants prevent you from getting a mammogram.
Dr. Judith Reichman, the “Today” show's medical contributor on women's health, has practiced obstetrics and gynecology for more than 20 years. You will find many answers to your questions in her latest book, "Slow Your Clock Down: The Complete Guide to a Healthy, Younger You," which is now available in paperback. It is published by William Morrow, a division of HarperCollins.
PLEASE NOTE: The information in this column should not be construed as providing specific medical advice, but rather to offer readers information to better understand their lives and health. It is not intended to provide an alternative to professional treatment or to replace the services of a physician.