MRI (Magnetic Resonance Imaging) uses magnets and radio waves instead of x-rays to produce very detailed, cross-sectional images of the body. This technology incorporates the use of computer software that processes the signals to generate these images, each of which shows a thin slice of the body. MRI studies do not expose patients to x-ray radiation.

Currently, MRI utilizing additional dedicated equipment called a breast coil is the test that physicians use to determine whether a silicone gel breast implant is intact or ruptured. The FDA recommends that patients have an MRI of their breasts 3 years from the time of surgery and then every two years after that. Although the rupture rate is not very high, if a breast implant has ruptured most women would want to replace it.

While most hospitals have MRI capability, few have the necessary technology required for breast imaging. Quincy Medical Center in conjunction with Alliance Imaging, Inc. is in the process of setting up their MRI equipment with a dedicated breast coil. Part of the set up included calibration of the equipment involving a patient who had silicone gel implants. Dr. Moss’ wife Carla, who has 200cc silicone gel implants, participated in this calibration. The following is a recap of her experience.

“I was delighted to be involved in the calibration of the new equipment for breast MRI. Since we may have patients who want to avail themselves of this test in the future, I find it advantageous to have experienced it personally. Having an MRI is not painful. While it does take about 30 minutes and involves lying on your stomach, you are able to move slightly in between the scan sequences. Most importantly, since you are lying on your stomach you are able to look up and out of the front of the MRI unit. Therefore, any sense of claustrophobia I might have had was essentially eliminated.”

This is a picture of Carla Moss lying on the MRI table. Her breasts are positioned in the breast coil which is anatomically designed to accommodate two breasts.

MRI’s of the breast are also used for detection of breast cancer. While breast MRI’s are not currently recommended for routine screening of patients who are not at increased risk for breast cancer, they are recommended as a screening test for women at high risk (greater than 20%) for breast cancer. It is recommended that women at moderately increased risk (15%-20%) discuss with their physicians the benefits and limitations of adding MRI screening to their yearly mammogram. The American Cancer Society classifies women at high risk as those with a strong family history of the disease or with a genetic mutation that predisposes them to breast cancer.

Whenever MRI’s are used for the screening of breast cancer the MRI is used as an adjunct to the mammogram, not as a replacement. An MRI is more sensitive (detects cancer more frequently) than a mammogram, however an MRI also has a higher level of false positives. This would mean that patients might have a higher number of unnecessary biopsies.

MRI tests are always read and interpreted by a radiologist. A radiologist is a physician who is trained to interpret many different types of imaging. He/she then dictates a written report that is provided to the physician who has ordered the MRI test. Radiologists who are involved in interpreting breast MRI’s receive training specific to this area of radiology.

This is an example of what an MRI looks like. The large oval in the breast is a 200cc silicone gel implant.

The radiologist who will be reading and interpreting the breast MRI’s at Quincy Medical Center is Dr. Nanci M. Mercer. Dr. Mercer received her MD degree from the Medical College of Pennsylvania. Her post-graduate training was at the Oakwood Healthcare System. She also completed two fellowship training programs as well. One was in Neuroradiology at William Beaumont Hospital and the second one was in Radiology at the University of Chicago. Dr. Mercer is also on staff at Boston Medical Center. Dr Mercer has been reading Breast MRI since 2004, and started Breast MR services at two hospitals prior to joining the BMC team last year.

Dr. Moss will be providing more information on the breast MRI capabilities at Quincy Medical Center once the department is able to schedule patients. Quincy Medical Center will be providing a comprehensive Breast MR service including state of the art vacuum assisted core biopsies under MR guidance. It is expected that patients will be able to be scheduled for breast MRI’s at Quincy Medical Center starting in either November or December, 2007.

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Read about Mammogram Requirements for Boston Cosmetic Breast Surgery. Information on how to get prepared for mammogram if you have breast implants.

Women age 40 and older should have a screening mammogram every year, and should continue so for as long as they are in good health.

Women at increased risk (due to family history, past breast cancer, etc.) should talk to their doctor about the benefits and limitations of starting mammograms when they are younger.

Dr. Moss’ mammogram requirements for cosmetic surgery of the breasts such as breast augmentation, breast lift, and breast reduction

All patients who are having cosmetic breast surgery, (breast augmentation, breast lift, or breast reduction) and are forty years of age or older, should have a current (within one year) mammogram. This is because all women forty years of age or older, should have a current mammogram to rule out breast cancer regardless of whether they want to have cosmetic breast surgery or not. Obviously, no surgeon or patient would want to proceed with a cosmetic procedure of the breast, without the standard screening tests being in order.

If a woman has a family history of breast cancer then her physician (primary care physician) may recommend that the mammogram screening start at an earlier age. If this is the case, then Dr. Moss would require a copy of this mammogram, before he would operate on her breasts. This again, is to insure that there are no problems that would preclude the patient having cosmetic breast surgery.

Dr. Moss’ requirements for consultations for cosmetic surgery of the breasts: Breast augmentation, breast lift, or breast reduction

Because Dr. Moss spends considerable time with patients during his consultations and most of these consultations are provided at no charge, Dr. Moss does require that the proper mammography screening be current before he will see a patient in consultation. It is as follows:

• If a woman is younger than forty with no family history of breast cancer, then Dr. Moss does not require a mammogram be performed prior to consultation.
• If a patient is forty or older and has had a mammogram within the last year then Dr. Moss would require a copy of this mammogram report prior to the patient’s consultation.
• If the patient is younger than forty and has had a prior mammogram then Dr. Moss would also require a copy of this mammogram report, prior to the patient’s consultation.
• If a patient is forty or older and does not have a current mammogram (within one year), then this patient will have to have her mammogram before Dr. Moss will see her in consultation. Dr. Moss’ office staff will assist you in scheduling this test if need be.

How does a patient obtain a copy of her mammogram report for Dr. Moss

If the mammogram was performed at Tobey Hospital, Jordan Hospital, or Quincy Medical Center, Dr. Moss staff can usually retrieve the report directly with no steps required by the patient (because Dr. Moss is on staff at these hospitals).

If the mammogram was performed elsewhere, call either the facility where the mammogram was performed or the office of your primary care physician and request that a copy of your mammogram be faxed to Dr. Richard A. Moss at 508-747-6613. Obtain the name of the person you spoke to and ask them when they expect this report to be faxed to Dr. Moss. Please note that some facilities will fax this report to Dr. Moss without a request in writing from the patient. However, many facilities may require the request be in writing. Then call Dr. Moss’ staff and give them the phone number of the facility (or physician’s office) you called, the name of the person you spoke to and when it was expected that the mammogram would be faxed. Dr. Moss’ office can usually obtain the mammogram once you have called them with this information.

If a patient is age 40 or over and does not have a current mammogram, Dr. Moss’ office will assist her in obtaining one.

If a patient has previously had a mammogram at a local facility, it may be easier for her to call her primary care physician to schedule her mammogram. This is because that facility already has her previous films on file to compare to the new mammogram. However, if the patient is having difficulty scheduling her mammogram in a timely manner, Dr. Moss’ office can assist the patient by scheduling her mammogram at Tobey Hospital. Tobey Hospital can typically schedule a patient to have a mammogram within two weeks.

The following pictures demonstrate what a patient should typically experience when having her mammogram at Tobey Hospital. Tobey Hospital is located in Wareham, MA and is one of the hospitals that Dr. Moss frequently performs surgery at. Both Dr. Moss and his wife, Carla have been patients at Tobey Hospital and have found their personal experiences to be wonderful.

If a patient has had prior mammograms elsewhere, it is important that she bring the films and reports from these mammograms to her mammogram appointment at Tobey Hospital. Simply call the previous hospital mammography department or mammogram center and request that the films and reports be available for you to pickup. Give the facility at least a few days notice. You should then pick up these films and reports at the previous hospital and bring them with you to Tobey Hospital, when you go for your mammogram.

Beth Bark Mammography Technician greets a patient who has brought her mammogram films and reports. This patient has had previous mammograms elsewhere.

Beth Bark, Mammography Technician, checks to see that all the appropriate films are in the patient’s packet.

A few important reminders:

This is an example of the mammography report that is sent to physicians.

Learn More About Breast Implant Surgery in Boston

• See Breast Implant Before and After Pictures
• Read Breast Augmentation Information on Our Web Site

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).

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.

Learn More About Breast Implant Surgery in Boston

• See Breast Implant Before and After Pictures
• Read Breast Augmentation Information on Our Web Site