Mammograms and Silicone Implants

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QUESTION: My wife had a total mastectomy, with no breast tissue remaining from the cancerous breast. She received a silicone implant as part of the reconstruction of the breast. She recently went for a periodic mammogram and the tech told her she should have a mammogram on the reconstructed breast. This differs from what we understood. She was concerned about rupture and refused, but she still has the question. Do you see any benefit from the mammography and is there a danger of rupture?

ANSWER: After mastectomy with an implant for reconstruction, there is NO role for mammography in follow-up, because all remaining tissues that used to surround the breast (skin in front, muscle in back) are obscured by the implant. If your wife were at high risk for local recurrence of cancer in the area where the breast used to be, she might benefit from MRI scanning by an experienced team. MRI can "see" around the implant. MRI may be able to detect recurrence as well as rupture of an implant. Most women do not have any routine radiographic testing of this area because their risk of local recurrence is considered minimal.

After mastectomy with a tissue reconstruction (for example, "TRAM" flap), mammograms may be helpful in a woman with a high risk of local recurrence or who has all kinds of lumps and bumps in the new reconstructed breast that need to be sorted out. Here, mammogram is used to evaluate the non-breast tissue located in the area of the removed breast.

Ask your doctor, who knows your situation the best, to make appropriate recommendations about your follow-up care.

—Marisa Weiss, M.D.

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