8 Things To Know About Breast Cancer Screening With Implants

Routine breast cancer screenings require special attention when you have breast implants. "It is not as simple as putting in the implants, and you're done," Jay Baker, MD, chief of the division of breast imaging at Duke University Medical Center, told Health.

"Downstream issues, like how implants affect regular screening mammograms, often aren't discussed in as much detail as they should be when a woman has implant surgery," said Dr. Baker.

Experts advise breast cancer screenings, called mammograms, annually or every other year starting around age 40, whether or not you have implants. The U.S. Preventative Services Task Force (USPSTF) advises that women and people assigned female at birth get mammograms every two years starting at age 40. Ask a healthcare provider whether you need a mammogram if you've had an implant after a mastectomy.

Do you have implants, or are you thinking of getting them? These facts and tips may help you navigate your regular breast cancer screenings and any related diagnostic testing your healthcare provider recommends.

1. Know How They Feel

Get to know your new normal if you've had breast augmentation or reconstruction. "We do recommend that if a patient has an implant in place, she becomes familiar with the implant," Sameer Patel, MD, associate professor in the department of surgical oncology at Fox Chase Cancer Center, told Health.

Talk to a surgeon about how you can tell what breast tissue is and what an implant is. People with implants may think they detect a lump in their breast, but what they're actually feeling is the implant. Saline implants, in particular, can bulge like a partially filled water balloon.

Research has shown that breast cancer is more likely to be detected at smaller implant sizes, especially palpable lumps found by self-exams or clinical breast exams. Dr. Baker urged any person who feels a lump to get it checked out. Don't assume any lump is the breast implant or ignore it.

2. Implants May Reduce Breast Cancer Detection

Mammograms don't sufficiently penetrate saline or silicone. It can be tougher to find on a mammogram, depending on where the cancer is located. "It is manageable; we do it all the time, [but] it definitely makes things a little trickier," said Dr. Baker.

Research has shown that the rate of cancer detection by screening mammography is 77.8% for women with implants. This rate is lower than that of women without implants, which is 90.7%.

"The outcome in patients that do develop breast cancer, even with implants, is the same as those without implants," despite the limitations of mammography screening in people with implants, said Dr. Patel. 

3. Inform the Mammography Team

When you make an appointment for a mammogram, tell the scheduler that you have implants. Ask if the staff has experience screening people with implants. Give the mammogram technologist a heads-up before your imaging procedure begins.

"The technologist needs to know two things. One is how to position the patient. The other is how much compression to use," said Dr. Baker. An experienced technologist will know how to carefully compress the breasts without risking rupture.

4. Extra Images Might Be Needed

The standard mammogram involves two views of each breast for a total of four pictures. People with breast implants typically require a couple of additional views of each breast. The extra views are gathered to detect cancers that the implants might obscure.

"They're called implant displacement views," said Dr. Patel. The breast is drawn out, pushing the implant toward the chest wall "so more of the breast tissue is visualized with the mammogram." 

Implant displacement views involve relatively little compression. A healthcare provider uses "just enough to keep the breast still," said Dr. Baker.

5. Implant Rupture With Mammography Is Rare

Are you worried that your implant might burst under compression? Research has shown that rupture is not a common occurrence. The Food and Drug Administration (FDA) has identified 17 cases involving breast implant rupture during compression.

There are almost 200,000 women who undergo breast augmentation each year. The implant could have been already compromised, "and the compression just helped it along," said Dr. Baker.

6. Other Types of Screening May Be Necessary

Mammography remains the tool of choice for breast cancer screening. Healthcare providers might recommend additional imaging if you have implants.

Ultrasound

"Usually, we only do ultrasound screening for women who are high risk [of breast cancer] or women who have dense breast tissue," said Dr. Baker. "A screening ultrasound is a consideration" if the radiologist has trouble seeing breast tissue because of implants.

Ultrasound is not a substitute for mammography because each yields different information. Mammography picks up tiny calcium deposits that can be a precursor to breast cancer, but ultrasound does not. Ultrasound may reveal a small mass hidden by the implant that mammography cannot detect.

Needle Biopsy

A needle biopsy may be done to extract a cell sample for lab testing if a suspicious area of breast tissue is found. "I always tell patients if there is a needle and an implant in the same breast, there's at least some chance of causing an implant rupture," said Dr. Baker. "It is rare, but it is absolutely possible."

7. There's a Risk for Lymphoma

Breast implants are generally not associated with an increased risk of breast cancer. Breast cancer risk is tied to such factors as age, being overweight, having a family history of the disease, or inheriting certain genetic mutations.

The FDA has found that breast implants can increase the risk of a rare type of lymphoma. This type of lymphoma is called breast implant-associated anaplastic large cell lymphoma (BIA-ALCL).

BIA-ALCL symptoms include:

• Breast asymmetry
• Lumps
• Pain
• Redness
• Swelling

Treatment usually involves removing the implants and surrounding tissue. A healthcare provider may advise chemotherapy and radiation therapy in some cases.

The FDA said it has received 1,264 reports of this cancer, including 62 deaths, as of 2023. In 2019, an advisory panel held a two-day hearing on the benefits and risks of the implants. The FDA also issued warning letters to two implant makers for failing to conduct long-term safety studies.

8. Complications May Necessitate Removal

Whether you should remove your implants if you're diagnosed with breast cancer is an individual decision. It's important to talk to a healthcare provider about the type of cancer you have and what treatment they recommend. 

A study published in 2022 found that women with implants who undergo radiation therapy for breast cancer are at increased risk of capsular contracture. Radiation therapy causes the fibrous tissue that develops around the implant to become hard, tight, and painful.

"In more extreme cases, it can actually affect the physical appearance of the breast, where it can deform the breast shape and be visible through the skin," said Dr. Patel.

There's no need to remove implants just for mammograms. "I would never recommend that a woman remove her perfectly functioning, intact implants to improve her screening," said Dr. Baker.

A Quick Review

Breast implants can impact breast cancer screening in different ways. You may have to become more familiar with your implants so you can properly detect lumps. You also may require additional screening like ultrasound, or a needle biopsy.

Seek out an experienced mammography team if you are due for a mammogram and have breast implants. In some instances, complications may necessitate breast implant removal. Always talk to a healthcare provider regarding any concerns you may have.