“Women who have undergone breast augmentation can be reassured that, even though implants may interfere with routine mammography evaluation, implants do not increase the risk of delayed cancer diagnosis,” says Leroy Young, MD, Co-chair of the Breast Surgery Committee of the American Society for Aesthetic Plastic Surgery (ASAPS). Commenting on a recent study published in the Journal of the American Medical Association ( JAMA ), which concludes that breast implants make it harder to spot signs of breast cancer during routine mammograms, Dr. Young says the study’s most significant finding is that augmentation patients diagnosed with breast cancer have a similar prognosis for recovery as women without implants.
“While these two findings may seem contradictory,” says Dr. Young, “the researchers rightly point out that breast augmentation patients may be more aware of their breast health, and therefore more diligent about seeking medical evaluation when they notice any changes in their breasts. They also note that breast implants may help patients manually identify unusual lumps or masses in their breasts, and this may lead to earlier diagnosis.”
The fact that the presence of breast implants makes it more difficult to effectively visualize breast tissue on an x-ray means that mammographers should use special techniques when examining women who have undergone augmentation. In addition to “displacement,” or pushing aside, of breast tissue, additional x-ray views are necessary. However, the JAMA study found that women with augmentation were no more likely to be called back for additional imaging or breast biopsy than women without implants.
The American Society for Aesthetic Plastic Surgery, the leading society of board certified plastic surgeons specializing in cosmetic surgery, offers the following guidelines for women who have undergone breast augmentation:
Mammography Guidelines for Augmentation Patients
Mammograms should be performed by technicians with experience in the displacement techniques required for better x-ray views of breast tissue. The presence of implants should be noted when making the appointment and again at the time of examination. Regular breast self-examination is useful and may be particularly effective as a method of early tumor detection when breast implants are present. Ultrasound is another technology that is highly useful in breast cancer detection. Magnetic resonance imaging (MRI), although expensive, provides the highest degree of accuracy and is unaffected by the presence of implants. Mammography is encouraged: for women over 40, every one to two years, according to guidelines from the American Cancer Society. Women with breast implants are encouraged to visit their plastic surgeons on an annual basis for routine examination. The JAMA study showed that mammography alone missed 55% of the cancers in asymptomatic women with augmentation and 33% in similarly aged women without augmentation.
The information that breast implants can partially obscure mammograms is not new, nor is the finding that breast augmentation patients, overall, are not diagnosed for breast cancer at a later stage than other women. There are other scientific studies supporting similar conclusions, as well as some that have suggested later-stage diagnosis of augmented women. A 2001 study by the National Cancer Institute of 13,500 women with breast implants found that there was no increase in breast cancer, no increase in breast cancer mortality, and no breast cancer detection delays. A study of 3182 augmentation patients in Los Angeles County showed no delay in breast cancer detection and a significantly lower than expected risk of breast cancer after an average of more than 14 years with breast implants.
“The finding that augmentation patients overall appear to have a lower rate of breast cancer than other women certainly deserves further research,” says ASAPS President Robert Bernard, MD, of White Plains, NY. “While we don’t yet know what factors may be involved, future studies may yield important information that can benefit all women.”
Further Information on Mammography and Breast Implants:
Miglioretti, et al: Effect of breast augmentation on the accuracy of mammography and cancer characteristics. JAMA , January 2004. 2004—Vol 291, No. 4
Status of Research at the National Institutes of Health, NIH Report to Congress, May 2003. National Cancer Institute Project: Follow-up of women with augmentation mammaplasty, project ID: Z01-CP10128, Study #42-92-00.
National Academy of Sciences Institutes of Medicine: Breast implants: status of research at the National Institutes of Health, May 2003.
Berg, et al: Single and double-lumen silicone breast implant integrity: prospective evaluation of MR and US criteria. Radiology. 197:45, 1995.
Brinton L.A., Breast cancer following augmentation mammaplasty ( United States ). Cancer Cause Control . 9:819, 2000
Brown, Silverman, Berg: Rupture of silicone-gel breast implants: causes, sequelae, and diagnosis. Lancet. 350:1531, 1997.
Deapen, Hamilton, Bernstein Brody: Breast cancer stage at diagnosis and survival among patients with prior breast implants, Plast Reconstr Surg 2000; 105:535-540
Deapen, Bernstein, Brody: Are breast implants anticarcinogenic? A 14-year follow-up of the Los Angeles study. Plast. Reconstr Surg . 1997-99: 1346-1353.
Gutowski: Saline-filled breast implants: a Plastic Surgery Educational Foundation multicenter outcomes study. Plast Reconstr Surg. 100:1019, 1997
Hadden. Silicone breast implants: a review. Australas Radiol. 42:296, 1998.
Handel, Silverstein, Gamagami, et al Factors affecting mammographic visualization of the breast after augmentation mammaplasty, JAMA , 1992, 286:1913-1917.
Silverstein, Handel, Steyskal, et al: Breast cancer in women after augmentation mammaplasty Archives of Surgery , 1988, 123:681-685
Silverstein, Handel, Waisman, et al: Augmentation mammaplasty with silicone gel-filled implants: its effect on breast cancer diagnosis. Proceedings of ASCO , Vol. 8, March, 1989
Silverstein, Handel, Gamagami, et al: mammographic measurement before and after augmentation mammaplasty. Plastic and Reconstructive Surgery , 1990; 86:1126-1130
Strom, et al: Cosmetic saline breast implants: a survey of satisfaction, breastfeeding experience, cancer screening, and health . Plast Reconstr Surg. 100:1553, 1997.