Breast implants and mammography--Is it safe? Do I have to worry about rupture?

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First of all, rupture is nearly impossible with the latest generation of cohesive silicone gel implants--and that is true for mammography as well as most any kind of "usual" or minor breast trauma. They cannot leak, and I believe that "periodic MRI scans" to check silicone implants for "leak" is both nonsensical and unnecessary. Rupture would require an exceedingly large force, and while mammography involves firm pressure on a woman's breasts, this is insufficient to damage implants. I have had patients in car crashes with injury to their breasts where the implants are undamaged, and just recently drained a breast hematoma (3 years after breast augmentation) in a woman who fell while snowboarding and struck her breast. Her silicone implant was undamaged, but she did injure her tissues, causing bleeding that required surgical drainage.

Saline implants are a slightly different consideration, as they have valves (to fill them with saline) and these valves can occasionally leak. Underfilled saline implants also have ripples which can flex with each breath, eventually weakening and developing a pinhole leak, leading to deflation, or rupture with a forceful blow or extreme pressure. Mammography has caused this in a few women with saline implants, another reason I prefer cohesive silicone implants (by any of the three USA manufacturers--they're ALL great products).

That being said, even saline implants are quite durable, and most radiologists and their technicians will utilize a displacement technique (Ecklund technique) to flatten and compress the breast tissue in front of the implants, avoiding much of the pressure on your implants. With these special techniques and an extra view or two, as well as newer digital technology, most radiologists can safely visualize 99% of an augmented woman's breasts.

There is one caveat here, however. If you have developed capsular contracture (firm, hard scar tightened around one or both of your implants), adequate mammography may not be possible since compression of the breast tissue is not feasible.

But if your breasts are soft, and especially if your implants are submuscular (also the best location to avoid capsular contracture), you needn't worry about mammography. It is extremely safe, but be sure that you not only properly mark the intake card all women fill out before their mammogram, but also tell the actual radiology technician that performs your exam that you have breast implants. If your breasts are soft and natural like we try to make them, they may not be able to "tell" without you informing them!  Dr. Tholen
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Minneapolis Plastic Surgeon