Imaging The Augmented Breast
In 2008, over 355,000 breast augmentation surgeries were performed in the U.S. It was the most frequent cosmetic surgery in the U.S. followed by liposuction, eye lid surgery and rhinoplasty (nose job). Currently, women of all ages, including those in the mammography screening population are undergoing this procedure and it is, therefore, important that they not only be aware of its potential complications, but also the effects it may have on their breast imaging.
Although most women fair well after surgery, early and late complications can include infection, breast pain, changes in breast sensitivity, capsular contraction, implant leakage or breakage, and possible need for additional surgery due to patient dissatisfaction.
Once a woman begins screening mammograms or undergoes diagnostic mammography, it is important that the procedure be performed at a facility which is experienced in providing mammography for the augmented breast. This examination will require that additional implant displacement views (Eklund Views) be performed so that visualization of breast tissue is maximized. Women undergoing breast augmentation should understand that oftentimes less breast tissue is seen even with the additional “implant displacement views”. Depending on the relative sizes of the woman’s native breasts and her implant anywhere from 20-70% of breast tissue can be obscured. Also, capsular contraction which occurs with the “aging” implant and implant leakage can contribute to suboptimal visualization of the breast.
An FDA study published in 2000 estimated that most women had at least one “broken implant” within eleven years of implant placement and that the likelihood of rupture continues to increase over time. If rupture or leakage is suspected then this is best evaluated with a specially tailored MRI exam.
In summary, a woman’s experience with breast implants is usually, but not always, uneventful for at least the first 10 years after surgery. However, it is important that women with implants remember that their lifetime risk of developing breast cancer is one in eight, just as in the general population. For this reason, it is mandatory that all women with implants receive their breast imaging at a facility experienced with the nuances of optimal imaging of the augmented breast.