- Question from Maja: It's been one year since I had a mastectomy and I am due for a mammogram. How are they going to view the mastectomy site?
About 20 years ago, some interesting research was done which showed that performing mammography on the side of the chest where a mastectomy had been done was of no benefit. If there was a new problem, the researchers found that it would be picked up first with a physical exam. That research was done on women who hadn't had implants or reconstruction.
More recently, research was done on women who'd had reconstruction; in many cases with a so-called TRAM flap procedure, in which abdominal fat and muscle are tunneled under the skin to the breast area. Researchers found that in a few of these women, there was evidence of breast cancer in the TRAM. It is very difficult to remove every cell of breast tissue during a mastectomy, and it's possible that a few remaining cells could be cancer cells that grew after the patient had a mastectomy. However, this situation is very unusual.
- Each one of you has a situation that is unique to YOU. You and your doctor should use the information we are giving you this evening to make the best screening and treatment decisions for YOU. If you've had mastectomy for a small cancer and all margins were widely free and clear and there was no lymph node involvement, the risk of recurrence in the area where the cancer developed is very low. If, however, you had a mastectomy for a large breast cancer, or one in which a significant number of lymph nodes were involved, the risk of local recurrence may be significant. In that situation, Dr. Brennecke, what is the best way to evaluate the area?
- Cecilia Brennecke As you said, each woman is unique. If a woman wants me to perform a mammogram on her mastectomy side, with or without reconstruction, I'll do it, because that's what she wants. I can tell her what the data shows, but if she wants a mammogram, she should have it. In terms of how to evaluate a woman who had a large tumor, we can do a physical exam, mammogram, ultrasound, or any combination.
- What about MRI?
- Cecilia Brennecke MRI can be very useful in certain situations. If there is a physical finding, such as a palpable thickening or lump, and the standard imaging of mammography and ultrasound are normal, or if there's intense scarring that makes the mammogram and ultrasound difficult to interpret, MRI may play a role by enabling us to see whether there is abnormal blood flow and contrast uptake in that area.
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