I recently read an article (http://www.newbeauty.com/dailybeauty/entry.aspx?id=4302) that said fat transfer breast augmentations can hinder breast cancer detection with mammograms. Is breast cancer more or less detectable with regular breast implants compared to fat transfer augmentations?
Is Breast Cancer Difficult To Find with Breast Implants? With Fat Transfer?
Doctor Answers 7
Breast implant make mammograms more difficult
The concern with the fat grafting and mammogram is not hindering the breast cancer detection ,but classifications that can be mistaken by radiologist as breast cancer and warrant biopsies. This is seen post breast reduction and breast lift. Breast implants on the other hand block the radiation and the tissue behind the implant not visualized. Radiologist will obtain extra views or ultrasound to examine the rest of the breast tissue. Breast cancer detection is not delayed by fat grafting. I have performed fat grafting on more than 210 patients and part of an ORB study at L.S.U. New Orleans and there been no delay in the breast cancer diagnosis.
Is breast cancer difficult to find with breast implants? With fat transfer?
It is known that women are more in tune with their breasts and more diligent with examination and feeling/knowing the contour of her breasts, thus able to identify any abnormality sooner. Imaging studies of the breasts are similar to imaging without breast implants and cancers are not hidden either by the presence of breast implants. You should remain proactive with your monthly self examination, annual clinical examination, and mammograms beginning at age 40 (unless family history, as directed by the Radiological Society).
Fat grafting to the breast has been controversial, for this possible concern. Recent studies have demonstrated the safety of fat grafting to the breast without any concern for causing, hiding, or spreading cancer. The architecture of the breast certainly is distorted once fat grafting has been done, but easily identifiable from true malignant lesions of the breast. Best wishes! Hope that this helps!
Breast Implants and mammography
Mammography can still be performed with breast implants in place. Mammography technicians are trained to use specialized techniques for women with breast implants that help to image the breast tissue around the curved surface of the implants. Be sure to let the mammography provider know that you have breast implants when you schedule your mammogram.
It is not possible to obtain a mammogram by imaging through the implants, only around them. Breast implants therefore potentially do reduce a radiologist's ability to visualize breast tissue completely. This is more of a concern with implants placed immediately behind the breast ('sub-mammary', aka 'sub-glandular' position), so for that reason the sub-pectoral position is strongly preferred.
There is no conclusive evidence which shows that women with breast implants are diagnosed with breast cancer at a later stage than women without implants - which one would expect if breast implants actually delayed the detection of breast cancer. Likewise, women with breast implants do not appear to have a higher mortality rate from breast cancer compared to women without breast implants. Breast implants do not obscure or interfere with patient self-examination or physician breast examination, which are at least as important as (if not more important than) mammography for breast cancer screening.
Mammography is currently the recommended mass screening test for breast cancer, but it has significant limitations due to a high number of false positives (which leads to biopsies when no cancer is actually present) and false negatives (which means a cancer is missed when it is present). The most sensitive and specific radiologic test for breast cancer is a contrast-enhanced MRI scan, which refers to an MRI that is enhanced by the administration of an intravenous 'contrast' agent. The contrast agent helps to 'light up' a breast cancer on the MRI scan when one is present. Breast implants do not interfere with breast MRI scanning in any way.
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Implants and Cancer Detection
Breast implants do complicate mammography, but research has shown that compensatory measures can be taken. Routine, two-view screening mammography may leave large portions of the breast unvisualized, resulting in an unsatisfactory exam. Studies show that mammographic accuracy can be improved when experienced radiologists use special techniques and extra views designed to maximize visualization of breast tissue ordinarily hidden by the implant. One such method (the Ecklund technique) involves positioning the breast so that the implant is pushed against the chest wall and the glandular tissue is pulled forward. Women who are over 35 years old should have an initial mammogram taken before breast augmentation. This can be valuable as a baseline for comparison of future mammographic x-rays. All women, including those with implants, should engage breast self-examination monthly and be examined by a physician once a year. They should follow the American Cancer Society’s guidelines for periodic mammogram: women with implants should use a skilled radiologist recommended by their plastic surgeon.
Any Type Of Breast Augmentation Can Interfere With Cancer Detection
Any form of breast augmentation has the potential to interfere with mammograms and delay the diagnosis of breast cancer. This is true of both saline and silicone implants as well as fat injection (possibly to a lesser extent). There were some implants available in the 90's which were filled with soybean oil and did not interfere with mammograms for which I served as an FDA investigator. However, there were other problems and they were recalled.
Breast Implants, Fat Grafting and Breast Cancer
Breast implants do not hinder breast cancer detection, for fat grafting the data is not yet in. When I started my practice in 1997, fat grafting to the breast was explicitly exempted from malpractice coverage by the Doctors' Company -- the largest malpractice company in the country for Plastic Surgeons. In lawyer speak fat grafting to the breast was a "non-covered event." (i.e. - You are on your own)
Breast implants are the most studied medical implants. Large studies with women with and without breast implants demonstrate that newly diagnoses breast cancers are the same types, the same size and the same prognosis. Breast implants behind the muscle in particular do not hinder self examination, ultrasound or MRI, and by using the Eklund technique and an additional oblique view mammography also works well. The Eklund technique increases the amount of breast tissue visualized from 56% to 64% for sub-glandular placement of implants and from 75% to 85% for sub-muscular placement.
For fat grafting it is more complicated. Some of the fat in a fat graft (0 to 50%) doesn't take (dies) and can leave irregularities in the shape of the breasts, firm areas in the breast and calcifications which can look like the calcifications seen in breast cancer. While this doesn't lead to breast cancer, it can look enough like breast cancer that you needing a breast biopsy to rule breast cancer out. If there are many calcifications it may make it harder to find a breast cancer.
When examining mammograms radiologists look for small white calcifications on the mammogram. In normal breast tissue the calcifications appear bright white like a star through a light mist at night. Since there are normally no or very few calcifications, they stand out. If fat grafting causes many calcifications, finding a new calcification is like trying to find a new star within a field of stars.
Fat grafting was abandoned because breast implants can provide larger, more predictable results. Larger fat grafts are more difficult to get to survive. Most "large" fat grafts are still at volumes less than the average breast implants used. Research is under way to combine suction expansion of the breast with fat grafting to allow larger grafts with better uptake. This involves several weeks of wearing large suction cups on the breast at night in preparation for the procedure.
Personally, I think it is still too early to jump onto the breast fat grafting bandwagon, with the exception of small grafts to fill contour defects. Smart people are working on it though. If you are considering fat grafting to enlarge your breasts you will want to find a board certified plastic surgeon who is doing so under research protocol. This way the data can be analyzed, and the questions we have today can someday be answered.
I recently attended the annual American Society for Aesthetic Plastic Surgery meeting in Boston. The link below it to an article about the position paper issued by the American Society of Plastic Surgery and the American Society for Aesthetic Plastic Surgery at that meeting after the first year of research into fat and stem cell grafting. They concluded that it is too early to tell the risks and benefits of grafting, and that the current available research is lacking.
Breast Implants do not affect breast cancer risk
While there are still some concerns about autologous fat transfer to the breast, there are several studies showing that breast implants do not appear to affect your risk of getting breast cancer. there are also studies showing that women with breast implants who do get breast cancer have the same survival rates as women with breast cancer who do not have implants. Your plastic surgeon should be able to provide you with more details if needed.
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.