Breast implants don’t increase your chances of developing breast cancer–but they don’t prevent it either.
When you have breast implants, routine breast cancer screenings (and related diagnostic procedures) can be a bit more involved.
“It is not as simple as
putting in the implants and you’re done,” says Jay Baker, MD, chief of
the division of breast imaging at Duke University Medical Center in
Durham, North Carolina.
“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, he explains.
While breast implants
don’t boost the risk of developing breast cancer, they don’t prevent it
either. 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. (More on that later.)
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.
Get to know your implants
If you’ve had breast
augmentation or reconstruction (or you’re considering one of these
procedures), 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,” says Sameer Patel, MD, associate professor in the department
of surgical oncology at Fox Chase Cancer Center in Philadelphia. Talk to
your surgeon about how you can tell what is breast tissue and what is
implant, he advises.
A recent study in the journal Plastic and Reconstructive Surgery suggests 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 can hide breast cancer on a screening mammogram
The X-rays used in
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 says.
In the same Plastic and Reconstructive Surgery
study above, the rate of cancer detection by screening mammography was
actually 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 says their
survival is no different: “The outcome in patients that do develop
breast cancer, even with implants, is the same as those without
implants.”
Always inform the scheduler and mammogram technologist
If you have implants,
say so. Tell the scheduler when you make an appointment for your
mammogram. Make sure 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,” Dr. Baker says. “One is how to position her.”
There are extra steps involved in screening a woman with implants (more
on that below). The other is how much compression to use.
According to the
Radiological Society of North America (RSNA), an experienced
technologist will know how to carefully compress the breasts of women
with implants without risking rupture.
Expect to have extra images taken
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.
“They’re called implant
displacement views,” says 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,” he explains.
Implant displacement views involve relatively little compression, “just enough to keep the breast still,” Dr. Baker notes.
Implant rupture with mammography is rare
Worried that your implant might burst under compression? 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 300,000 women who undergo breast augmentation each year, says the American Society of Plastic Surgeons.
In many rupture cases, Dr. Baker suspects the implant was already compromised “and the compression just helped it along.”
Additional screening may be necessary
Mammography remains the tool of choice for breast cancer screening. But sometimes doctors 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 explains. But if the
radiologist has trouble seeing breast tissue because of implants, “a
screening ultrasound is a consideration.”
Ultrasound is not a
substitute for mammography, he adds, 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 but real 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 says. “It is
rare,” he adds, “but it is absolutely possible.”
What you think is a lump might be your implant—but get it checked anyway
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
points out. But he urges any woman who feels a lump to get checked out.
Don’t assume it’s the implant and ignore it!
“A woman who has
implants is not at increased risk of developing breast cancer,” he says,
“but it does not prevent her from getting breast cancer.”
Implants are associated with 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. The FDA
says it has received 457 reports of this cancer, including nine patient deaths. At least 310 of these cases involved textured implants.
The FDA is 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.
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.
You may need to remove your implants (but not for breast cancer screening)
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.
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 says.
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 says.
