Screening and diagnosis of breast cancer in augmented women

Abstract

Cosmetic breast enlargement surgery has become common in Japan. There are some reports suggesting that implants can interfere with mammography (MMG) and may lead to delayed breast cancer diagnosis, even when implant-displaced MMG (Eklund technique) is performed. Screening MMG was recommended in a notification issued by the Japanese Ministry of Health, Labor and Welfare in 1999, and MMG is just coming into widespread use in Japanese breast cancer screening. Recent reports suggest that screening MMG may not be appropriate in augmented women, but breast self-examination may be effective in these women. Ultrasonography (US) may be useful in screening augmented women without risk of rupturing the implant. In appropriate cases, magnetic resonance imaging should be considered as an adjunct to MMG and US. The question of whether augmented women should not undergo core needle biopsy because of the possibility of damage to the implant should be considered. This review discusses diagnostic methods for augmented women and suggests the optimal screening method for augmented women. The challenge of the screening and diagnosis of breast cancer in augmented women is important in order to detect more of their cancer at a preclinical stage, because we can expect to see breast cancer in augmented women with increasing frequency over the next decade.

Imaging in patients with breast implants—results of the First International Breast (Implant) Conference 2009

“…The only situation where most participants agreed about MRI making sense was a suspicion of tumor in the augmented breast, and this view is in accordance with the literature [e.g., 9, 18, 19, 26]. However, MRI is currently considered to be a second-line method to be applied after mammography has yielded a suspicious result that could not be verified or falsified by ultrasound examination or in cases of peri-implant positivity at clinical examination with inconclusive results of conventional imaging [19, 22]. The same applies to the diagnosis of implant rupture where the value of MRI is undeniable, but its application limited to cases with inconclusive results of conventional imaging [5, 9, 26, 27].…”

“…The suspected relationship between breast implants and cancer has essentially been disproved, but considering the high number of women with implants, cancer diagnosis in the augmented breast is a major issue [15, 20]. The mainstay of tumor screening and diagnosis in the augmented breast is—just as in non-operated patients—mammography and ultrasound in that order [22]; however, the sensitivity of both methods for cancer detection may be reduced in augmented breasts [11, 21], and patients ought to be informed of this fact before they undergo surgery. Therefore, the re-evaluation with MRI—which is discussed elsewhere in this paper—may become more important in augmented breasts, but currently the literature provides no sufficient evidence for its recommendation [21].…”

“…Since implants present very well on sonography and other imaging modalities, a decline in the number of interventional biopsies would hardly be justified. However, an interventional core needle biopsy has to be performed with particular care in order to avoid iatrogenic implant rupture [22]. …”

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

“…When mammography is performed to assess the remaining tissue with this type of reconstruction, the density of saline or silicone used in the implant will interfere with the study regardless of the type and location of the implant. A review article by Uematsu [29] addresses screening in patients with augmentation utilizing mammography, US, and breast MRI. The author refers to the Eklund technique in order to address the issue of the implant interfering and potentially obscuring a mass.…”

Breast Care in the Transgender Individual

“…Unfortunately, there is little agreement about the preferred method of screening the MtF person with breast implants. Uematsu conducted a review of the various options for breast cancer screening in augmented women, including a discussion of implant‐displacement mammography, ultrasonography, and MRI . Mammography was identified as the optimal screening tool when supplemented with regular self and clinical breast examinations.…”