Are mammograms more difficult after Breast augmentation?
Doctor Answers 10
Mammography and breast implants.
Although there is a slight chance that mammography might cause leak or rupture of a saline breast implant, this is less likely with a soft, non-contracted breast, with smooth implants, and with submuscular placement. (The present generation of silicone implants is cohesive and cannot leak.) Improperly-performed mammograms can forcibly compress and rupture the scar capsule around any kind of breast implant, so it is important to let the radiologist and technician know that you have breast implants. A radiographic method called the Ecklund technique (also known as the displacement technique) compresses the breast tissue in front of the implant, and not only increases the visibility of breast tissue in the mammogram, but also reduces pressure on the implant. I do recommend a baseline mammogram one year after augmentation, so that any scar tissue or calcium deposits within the breast are documented and available for comparison with any subsequent mammogram.
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. Under-filled 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. This is particularly true with teardrop-shaped, textured implants with their peaks and valleys (weak spots) because of the texture. Mammography has caused leakage/rupture 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 bring 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. So, I hope your surgeon is suggesting submuscular placement, not only for mammography but also to minimize the risk of capsular contracture. (Above the muscle has a higher risk of capsular contracture, as does axillary placement, due to the bacteria in armpit glands).
But if your breasts are soft, and you don't develop 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!
Do you really want "anatomic" (teardrop-shaped) implants?
I'm sure you know that breast implants come in both round and teardrop (so-called "anatomic") shapes. While some plastic surgeons prefer the teardrop-shaped implants in some situations, smooth round implants are generally the softest, most natural in appearance (upright and lying down), least likely to be felt externally, and (for saline implants) least likely to leak. They also cost less than teardrop-shaped textured implants.
Textured surface implants have a thicker shell, are more likely to be felt externally, and have a somewhat higher leak rate (saline implants) because of the thinner or weaker areas in the tiny peaks and valleys of the shell surface. Since teardrop-shaped implants must have proper positioning and must stay in that position (sloped part up, rounded part down) to take advantage of their innate shape, by necessity they are textured so that the body's tissues can adhere to and maintain the proper position of the implants. (Upside-down teardrop implants really would look weird.) Even less major malposition asymmetries are “stuck” and remain a bit “off” in appearance. This adherence also makes initial positioning critical—textured implants do not settle or drop over time. Post-op tissue swelling and tightness diminish, giving a softer feel, but position (by definition) is determined by the initial placement and adherence. This (proper positioning) is an even more difficult proposition with axillary incisions.
In other words, if they rotate before they "stick" or adhere properly to your tissues, they will stay in that "weird" position. And if they become "un-adhered" later, then, yes, they can rotate, and any position other than the one "perfect position" is going to be "off."
Since teardrop implants are designed to adhere to tissues, they also do not move very much at all as you change from a standing to a reclining position. Teardrop implants remain teardrop-shaped when the patient is lying down, whereas the natural breast flattens out and assumes a round appearance. Did I already say that teardrop implants are also more costly than round smooth implants? The smooth round implant does just what a natural breast does: it is teardrop-shaped when the patient is upright, and flattens and drops slightly to the side when the patient reclines.
Thus, round implants are actually more anatomically realistic than teardrop, or so-called “anatomic implants.”
Some implant manufacturers and plastic surgeons have suggested that the “anatomic” or teardrop-shaped breast implant has a more natural look than a round implant, and much advertising and marketing has been used to promote “anatomic” implants to the public. These implants are perfectly good devices, but are more expensive and have more issues than smooth, round implants, and whether or not they are truly more "anatomic" is questionable.
A recent study compared actual women with smooth, round implants to women with textured, teardrop-shaped implants. Mammograms were performed in upright and supine (lying-down) positions, and digital tracings computerized and compared. Both the round and teardrop-shaped implants had a sloped, teardrop shape when the women were upright. In fact, in upright patients, teardrop and round implants were indistinguishable on X-ray. But when a woman is lying down, the natural non-augmented breast flattens, drops to the side of the chest, and assumes a round shape, as does the round smooth implant. The teardrop-shaped implant stays teardrop-shaped in the lying-down position, which makes this unusual appearance actually less anatomic than the round implant!
Perhaps another consultation or two with ABPS-certified plastic surgeons experienced with breast augmentation might be in order. You ask good questions, but your surgeon should have answered these before "selling you" on the idea of teardrop, textured, (?saline), (above the muscle?), trans-axillary augmentation. Click on the web reference link below for my Comprehensive Guide to Breast Augmentation--you might recognize some of the text above. Best wishes! Dr. Tholen
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Are mammograms more difficult after Breast augmentation?
Sub muscular ( dual plane) breast implant positioning decreases this interference compared to the sub glandular breast implant positioning. Based on studies that I am familiar with the loss of breast tissue visualization caused by sub muscular breast implants is approximately 6%.
I hope this helps.
Mentor Breast Implants and Mammograms
Yes, mammograms can be performed after breast augmentation. The mammogram will usually be a diagnostic mammogram instead of a screening mammogram.
To be sure, see two or more experienced, board-certified Plastic Surgeons in your area for a complete evaluation to make sure you are a good candidate and that it is safe for you to have breast implant surgery.
I hope this helps.
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