Mammograms after Different Types of Breast Surgery

If you’ve had surgery for breast cancer, such as lumpectomy or mastectomy, or you’ve had breast implants, you’ll likely follow different recommendations for having screening mammograms than women generally do.

Mammograms after lumpectomy

If you had a lumpectomy (removal of the cancerous lump, along with a margin of healthy tissue) plus radiation therapy, you can expect to have a mammogram of the treated breast about 6 months after finishing treatment. Radiation can cause some changes in the breast tissue and skin. This 6-month mammogram will become the new “standard” against which future mammograms of the remaining breast tissue are compared.

If you had reconstruction with your own tissue after a lumpectomy, your doctor likely will order a baseline mammogram after the tissue has healed. This also will be helpful for interpreting future mammograms.

Six months later, you can expect to have your usual yearly mammogram of both breasts. From this point on, your doctor may say that yearly mammograms are sufficient. Or, he or she may recommend that the treated breast still get a mammogram every 6 months for the next few years. Talk to your doctor about the plan that is best for you.

Mammograms after mastectomy

Mastectomy involves the removal of the entire breast. If you’ve had a mastectomy, no follow-up mammograms are needed on that side because all of the breast tissue has been removed. You will continue have yearly mammograms as usual on the remaining breast, unless you had a double mastectomy (both breasts removed). Those screening mammograms on the other breast are especially critical, because having cancer in one breast raises your risk of developing cancer in the other.

Mammograms will be recommended if you had a special type of mastectomy called nipple-sparing mastectomy, also known as subcutaneous mastectomy. In this surgery, you keep your nipple and the tissue just under the skin. Enough breast tissue remains to warrant the continued use of screening mammograms.

Mammograms after breast reconstruction

If you have reconstruction after mastectomy, you may wonder if you should have mammograms on the reconstructed breast. In most cases, the answer is no, unless you had a nipple-sparing mastectomy.

• If you've had saline or silicone implants for reconstruction, you won't need mammograms of the affected side. No breast tissue remains, and the implant blocks the view of surrounding tissues. With an implant, however, you and your doctor can still do a careful physical examination of the breast area.
• In general, if you’ve had autologous reconstruction (reconstruction using tissue from another part of your body), typically you will not need mammograms of the affected breast. Again, this is because no breast tissue remains. Regular physical exams of the reconstructed breast will be performed. Under some circumstances, however, doctors may recommend mammography after this kind of breast reconstruction:
  • if you're at high risk for local recurrence
  • if physical examination of the breast is difficult
  • if there is a questionable abnormality

Usually, lumps and calcifications in reconstructed tissue that can be felt and are visible with mammography are benign fat necrosis. This is the result of fat cells dying after the reconstruction procedure. These cells calcify and form lumps soon after the surgery, and unlike cancer, they usually stay the same size or get smaller over time.

Breast MRI is another and possibly more effective way to screen women who have had breast reconstruction and are at high risk for recurrence.

The above are just general guidelines. Talk to your doctor about what he or she recommends for you.