If you had a breast completely removed (mastectomy) and reconstructed, future screening mammograms on your reconstructed breast (or breasts) are not needed. Currently, there is no data to support the value of routine screening mammography after mastectomy and reconstruction — whether you had an implant or flap reconstruction. (The only exception is the use of MRI screening to detect possible rupture of a silicone implant — see below.)
If you’ve had double mastectomy with reconstruction, no mammography screenings are needed. Some surgeons may recommend a baseline mammogram or MRI after reconstruction, just to have a basis for comparison if anything unusual develops in the future. Yearly physical exams and monthly self-exams are considered sufficient, with imaging being done only if something unusual is found. (See our Breast Self-Exam page for more information about how to perform them.)
If you had flap reconstruction and you feel a lump or hardness, this is usually a case of benign fat necrosis — 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. Your doctor often can confirm this through physical examination. Occasionally, a mammogram, ultrasound, or aspiration biopsy (removal of tissue using a fine needle) may be required to confirm a benign fat necrosis.
If you had implant reconstruction and you feel hardness in the breast area, it may be the result of capsular contracture. Capsular contracture occurs when a hard tissue capsule forms around the implant. It can be small and barely noticeable, or it can become very painful and distort the shape of the breast. Let your doctor know if you see or feel any of these symptoms.
If you kept a healthy breast, or you had a lumpectomy with some reconstruction, then you still need annual cancer screenings with mammography or some other imaging test, such as MRI. You also should perform monthly breast self-exams and have annual breast exams by your doctor.
Screening is sometimes needed for special circumstances:
MRI screening for silicone implant rupture
If your doctor used a silicone implant for your reconstruction, the FDA recommends that you receive MRI screening for possible rupture 3 years after receiving your implant and every 2 years after that for the rest of your life. If a silicone implant ruptures, the gel leaks out slowly and you may not even realize it happened. Getting health insurance to cover MRI for this situation can be challenging, so you may have to work with your doctor’s office on this.
Screening of a healthy breast with an implant
If you had an implant placed in your healthy breast to achieve balance with your reconstructed breast, this will change how that breast is screened for cancer. Mammography X-rays can’t pass through silicone or saline implants well enough to show all of the breast tissue around the implant. So you can expect the technician to take extra views of the breast. These are called “implant displacement views,” in which the technician is able to push the implant back against the chest wall and pull more of the breast tissue forward. This makes more of the tissue viewable on the mammogram. Make sure that the technician is experienced at performing mammograms on breasts that have implants.
Screening after nipple-sparing mastectomy
Nipple-sparing mastectomy removes all of the breast tissue but preserves the nipple. Today’s approaches to this surgery are quite successful at making sure all of the breast tissue is removed. In past years, though, nipple-sparing techniques were known to leave some breast tissue behind. If you had this type of mastectomy in the past, check with your doctor to see if ongoing cancer screenings are needed.
Screening for high-risk women
Although screening after reconstruction generally isn’t recommended, there are no hard-and-fast rules. If you have a strong family history or genetic test result that put you at high risk of breast cancer, or your doctor believes you’re at high risk of local recurrence, then future screenings may be recommended even though their value isn’t proven. MRIs generally would work better than mammography because they offer more detailed images; however, they can be difficult to interpret and have a high rate of “false positives” — something that looks suspicious but turns out to be nothing.
If your doctor does recommend screenings, ask which test is best for you: mammogram, MRI, ultrasound, or some combination of tests. Generally, it’s best to wait at least 6 months after reconstruction to start screenings. Also, be sure to let the imaging center know that you have breast implants and/or a flap reconstruction.