Read about the mammogram processes for Boston breast implant patients. Know more about reading and interpreting mammograms in breast implants.
All women who are 40 years of age need to have an annual mammogram for the purpose of screening for breast cancer. Women who have a family history of breast cancer may be advised by their primary care physician to start this screening at an earlier age. When it comes to the time frame and frequency of screening for breast cancer with a mammogram, women who have breast implants should be treated exactly as women who don’t have breast implants. In other words, women with breast implants should have their first mammogram at age 40, unless there is a family history of breast cancer. If a woman, who has breast implants has a family history of breast cancer, then her primary care physician may start her screening process at an earlier age, similar to that of a woman without breast implants.
Dr. Moss finds that sometimes women are concerned that the process of having a mammogram can damage their breast implants. This concern is especially prevalent in patients who have already undergone mammograms prior to implantation with breast implants. These patients are concerned that their implants are going to be “squished” in the mammography machine and therefore their implants will “leak” or rupture prematurely. Dr. Moss wants to put his patients at ease and let them know that this should not be the case. This is because mammograms are performed differently when a patient has been implanted with breast implants. The mammogram is performed in a way that applies very little pressure to the breast implants.
When a patient who has implants, has her mammogram, there are two sets of mammograms performed for the radiologist to read. The pictures in this article demonstrate these two mammogram tests being performed in a patient who has silicone gel implants, implanted beneath her pectoralis muscle. The test is identical for patients who have saline implants beneath their pectoralis muscle. It is also similar when the patient has her implants placed above the pectoralis muscle (either saline or gel).
Slight Compression Oblique 
Slight Compression FrontalThe first pictures that are taken are done so with the entire breast in the machine. Only light compression is applied to the breast, far less than is applied if there is no implant in the breast. The breasts are filmed from two different angles, frontal and from an oblique angle. Again, in neither situation is the breast compressed with pressure, high enough to damage the implant. Both breasts are filmed at each angle, when this portion of the mammogram is performed.The second set of films is performed in what is commonly referred to as the Ekland views. This method is also referred to as “implant displacement.” In this instance the mammography technician will push the implant against the patient’s chest wall and pull the breast tissue that is in front of the implant forward. This breast tissue is then compressed in the normal fashion and filmed. Please keep in mind that while the breast tissue is compressed, the breast implant is not included in the area of compression. In other words, the breast implant is pushed back against the patient’s chest wall and remains outside of the area being compressed and filmed. Both a frontal view and oblique view of each breast is filmed under these conditions.
Technologist displaces implant (frontal view) 
Tissue in front of implant being compressed between mammogram plates (frontal view) 
Technologist displacing implant (oblique view) 
Displacement continues 
Compressed tissue in front of breast implant (oblique view)A patient need not worry that “implant displacement” will result in their implants being situated in the wrong position after the mammogram. Once the breast is removed from the two plates of the mammogram machine, the breast returns to its normal shape.
This patient just had both the regular views filmed and the displacement views filmed of her right breast. No views were taken of the patient’s left breast. Although there is a slight redness (patient’s right breast) which will quickly disappear, the breast implant remains in the correct position.Because of the two different ways the breasts are filmed, it takes twice as long to perform a mammogram on a patient who has implants. That is why when scheduling these mammograms the hospital scheduler will always ask, “Do you have breast implants?” In a normal mammogram, there is a minimum of 4 films (two per breast) taken, but in a mammogram of a woman with breast implants, there will be a minimum of eight films (four per breast) taken.Most professionals agree that when a woman has breast implants, it is easier to perform her mammogram if her implants are beneath her pectoralis muscle, rather than above her pectoralis muscle. Dr. Moss routinely places all breast implants beneath the pectoralis muscle whenever possible. There are many advantages to placing breast implants beneath the pectoralis muscle, besides allowing mammograms to be performed more easily. However, the scope of this article does not allow us to delve into this issue.If a woman had a breast implant in only one breast (for example, breast asymmetry or breast reconstruction) then the mammography technician would perform the mammogram in a manner that is appropriate for each individual breast.The films are usually processed immediately so that the technician can determine whether all films have been taken appropriately. It is not uncommon for a film or two to be retaken immediately on the spot.
After the films are processed, a radiologist will “read” and interpret the films. Radiologists are the “board certified” specialists who are properly trained to interpret these films. The American College of Radiology (ACR) has developed a standard way of describing mammogram findings. In this system, the results are given a code (numbered 0 through 6). This system is called the Breast Imaging Reporting and Data System (BIRADS). It is important that when a surgeon requests a copy of a patient’s mammogram, the patient requests a copy of this report from either their primary care physician or mammography department. It is not adequate to send a surgeon a copy of the letter that the patient typically receives from the mammography department/radiologist. This is because the letter that the patient receives does not give the BIRAD system, but rather gives the patient an interpretation designed for the lay public, not the medical community.
Dr. Anne Ruggieri, a radiologist at Tobey Hospital (also on staff at St. Luke’s Hospital in New Bedford and Charlton Hospital in Fall River), reading and interpreting mammogram films.
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