Mammography of the Postreconstruction Breast

Abstract

Experience with mammographic examination of the reconstructed breast after mastectomy is limited. Typical mammographic changes associated with breast reconstruction are described. When these changes are identified on mammography, they can prevent patients from having unnecessary biopsies and can alleviate patient anxiety. A retrospective review of all mammograms performed in our breast center was made to identify typical as well as unusual findings on the postreconstruction mammogram. The findings were correlated with the type of reconstruction and the physical examination findings. Mammography after mastectomy and breast reconstruction was performed in patients with palpable abnormalities, a suspicion for implant failure, or for patient anxiety. In the postreconstruction patient with a palpable mass, features characteristic of fat necrosis were the most frequent abnormal findings on mammography. Unusually placed implants or focal implant ruptures may explain a mass discovered on breast physical examination. Imaging of the reconstructed breast after mastectomy yields typical mammographic findings. Fat necrosis can be identified on mammography and may explain a new palpable mass on physical examination. Mammography continues to be useful to identify a postoperative complication or implant failure and to differentiate it from tumor recurrence.

Fat Grafting to the Breast Revisited: Safety and Efficacy

“…Four patients developed benign-appearing calcifications easily distinguishable from cancer, and three patients developed small nodules that revealed fat necrosis on aspiration. These abnormalities were similar to those described after breast reduction, [8][9][10]21,46 breast reconstruction, 18,22,23,47 and liposuction of the breast. 16,24 …”

“…[12][13][14] Now, in 2006, radiologists can distinguish with a high level of confidence the calcifications that are a result of fat necrosis from calcifications that are related to breast cancers. [15][16][17][18][19][20][21][22][23][24][25] Because of the American Society of Plastic and Reconstructive Surgeons 1987 position paper, physicians have been hesitant to discuss fat grafting to the breast, creating a remarkable paucity of information on this topic. Despite the "veil of silence" that the position paper has imposed on the plastic surgery world, physicians are using grafted fat for augmentation and breast reconstruction.…”

Fat Injection to Correct Contour Deformities in the Reconstructed Breast

“…Despite some reports of the utility of this practice, [12][13][14] it is still a matter of debate in the literature 15 and, in our current opinion, not warranted. The three patients in our series who did return to us with mammograms or ultrasounds were the three with palpable masses.…”

A review of breast imaging following mastectomy with or without reconstruction in an outpatient community center

“…Recurrence rates in patients who have undergone a TRAM flap reconstructive surgery have been reported at 4-11%, most within the first 5 years [8][9][10]. Several papers had reported early detection of recurrence on screening mammography of the reconstructed breast [11][12][13][14], resulting in the adoption of routine screening for these women.…”