Orange County Register

Breast Cancer Awareness Month brought with it some new initiatives to educate women about problems that breast implants can cause in spotting early signs of cancer.

To solve those problems, some doctors suggest that women with implants should use MRIs as a supplement to traditional mammograms.

Mammography misses 55 percent of the breast tumors in women with implants, vs. only 33 percent in other women, according to medical research cited by the BreastImplantInfo.org site.

That’s the context for last month’s launch, during Breast Cancer Awareness Month, of a public-service campaign by the NewImage.com plastic-surgery referral and information site. Its goal was to encourage women with breast implants “to go beyond regular mammography screenings to reduce the risk of possibly missing a tumor hidden under an implant.”

The recommendations included choosing a mammography site with experience in recording and reading mammograms of women with implants. It mentioned MRIs and ultrasound as alternatives that might produce better images.

In practice, many plastic surgeons say they see few mammography problems because of implants.

Plastic surgeon Dr. John Di Saia of San Clemente says that, in his experience, patients with larger implants, silicone-gel implants and implants over the breast muscle tend to have more problems with screening. But he adds, “cases of delayed diagnosis of breast cancer are very few overall.”

Plastic surgeon Dr. Brent Moelleken of Beverly Hills notes that about 10 percent less of the breast tissue shows up on a mammogram, but several of his patients actually found early breast cancers because they had implants. The reason is that the implant provides a better platform for a woman’s self-examination of her breast, he says.

Overall, no increase has been spotted in implant patients’ cancer death rates, Moelleken says.

Last month, Dr. Paula Kue of Johns Hopkins Medical Institute debunked the idea that women with implants cannot get mammograms. Writing for Yahoo Health, Kue described the myth and the reality:

Myth three: I have breast implants, so I can’t get mammograms. False! Mammograms are still a must. Some physicians are considering moving toward other imaging modalities like MRI for those with implants, but for now the trusty old squish of the mammogram is still the chief way of checking. If you have implants, talk with your doctor and breast radiologist annually about any technology updates.

Doctors at Harvard Medical School say implants only rarely break under the pressure of a mammogram, but they add that a mammography center needs to spend extra time testing women with implants. Writing in the HealthCentral Network site, they say:

It is very rare for an implant to break open during a mammogram, but it has happened. It is important for [a woman with implants] to tell the radiology technician that she has implants before the mammogram.

In fact, it is more important that she inform the radiology center about the implants when calling to schedule the appointment so they can allow for more time. Since the implant interferes with the quality of the images of breast tissue, additional views and techniques to obtain better images of the breast tissue are used. Specifically, you want to ask the radiology technician for implant displacement views (Eklund views).

The technician will try to push the implant out of the image as much as possible to get a better image of the breast tissue. Pushing the implant aside can also protect it from rupture. …

The physical exam and X-ray mammograms can be more difficult to interpret, especially if thick scar tissue forms around the implant. Studies to date, however, show no increase in breast cancer risk and no delay in diagnosis or difference in survival. What may make more of a difference than the presence of the breast implant is how well a woman keeps up with recommended breast cancer screening.

Anyone with breast implants should make sure to conduct a self-breast exam each month to better understand the normal contours of your own breast tissue. While scarring around an implant might create a harder texture, you should not feel any lumps. Make sure you see your health care provider for any changes on your self-breast exam or any lumps.

Harvard doctors don’t favor MRI screening instead of regular mammograms. They say:

MRI (magnetic resonance imaging) is not considered better than X-ray mammography for imaging breast tissue. While MRI is better at detecting breast implant ruptures, routine mammography is more reliable for breast cancer screening.

NewImage.com proposes tests in addition to mammograms:

Breast implants make it more difficult to detect breast cancer on a mammogram because the implants can hide some breast tissue and block the image of a tumor. Because of this, standard techniques used in mammography for compression of the breast and imaging are not as effective for women with breast implants and additional screening tools, such as MRI and ultrasound are recommended.

Even many MRI proponents consider them supplements, not replacements, for mammograms. For example, Sacred Heart Women’s Hospital in Pensacola, Fla., has a new MRI machine made specifically for breast screening, but it’s not promoted as a tool that replaces mammograms:

Using a powerful magnetic field and radio waves, the breast MRI captures multiple cross-sectional pictures of the breast, providing valuable images of conditions that cannot be obtained by mammography or ultrasound. However, MRI of the breast is not a replacement for these more traditional screening procedures, but rather a supplemental tool for detecting and staging breast cancer and other breast abnormalities.

BreastImplantInfo.org adds:

Women with breast implants and those considering breast implants need to know that they will have a different mammography experience than women without implants, since standard techniques for compression and imaging are ineffective with implants. The special techniques used will push the implant back to try to move it out of the way, and extra views will be taken.

Even so, mammograms performed on women with implants will still miss more tumors than is typical of mammograms for women who do not have implants.

In addition, women with implants should expect that mammography will require more views and take longer, thus costing more and exposing them to increased levels of radiation. Unfortunately, the most common problem, capsular contracture, can make mammography more painful, less accurate, or even impossible to perform. In such cases other, more expensive tests, such as an MRI or ultrasound, may be required.

There’s some evidence that the pressures of a mammogram can rupture implants, which tend to break after 10 to 20 years anyway.

Di Saia said patients often do not know when an implant ruptures:

” I have seen very few re-operative patients who know when their implants may have ruptured. Of this number, none stated they knew it happened at mammography.

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