Several weeks have passed since Angelina Jolie’s eye-opening op-ed article in the New York Times about her double mastectomy and the subsequent flood of attention in the press and social media, including Baptist’s Health Life and Community blog [1]. A lot of excellent information was disseminated globally, which is exactly what she was hoping her announcement would do – spread the word.
Ms. Jolie opted to have a double mastectomy after learning that she carries a mutation of the BRCA 1 gene, which greatly increases her risk of developing breast and ovarian cancer. Now that the dust has settled, we need to take a closer look at how her decision might personally affect you. You will be comforted to know that most of us do not carry the BRCA genes, even women who are diagnosed with breast cancer. According to Susan G. Komen [2], only 5-10 percent of all breast cancers in the U.S. are due to inherited genetic mutations, so the likelihood that you are a carrier is not high.
Here’s where you come in. Part of the reconstructive process after a double mastectomy is to insert breast implants. How many of you have considered having, or now have, breast implants? Do you know how having breast implants affects mammograms?
To get the answers, I reached out to Baptist Health Breast Center and spoke with Joanna Tewfik, D.O., one of the attending radiologists.
“This is a very good question – especially in Miami, where our radiologists see many implant cases each day,” Dr. Tewfik said. “Mammograms can still be read accurately if you tell the mammography center that you have them. While it is true that implants do obscure portions of the mammogram, additional images are taken in order to help view as much tissue as possible.”
These are some of the other things I learned from Dr. Tewfik:
• The technician and radiologist should know how to perform mammography on patients with breast implants, but it is up to you to make sure they know.
• Before your examination, you will be given a patient questionnaire that asks about any prior breast surgeries, including breast augmentation. It is important to complete this part.
• Instead of two views of each breast as in a routine mammogram, a mammogram for someone with breast implants includes four views of each breast. In addition, two “implant displaced views” are performed for each breast in order to move the implant posteriorly and view more of the normal breast tissue.
• Ultrasounds and MRIs may also be recommended if you have breast implants.
• Additional studies may also be recommended if you have a strong family history of breast carcinoma or if you have known dense breast tissue and/or fibrocystic breasts.
“There are several things you can do as a patient in order to help provide a near perfect mammogram,” Dr. Tewfik said. “But first it is important to understand the ‘whys’ of the mammogram procedure.”
Positioning is very important for a good mammogram.
Cancer likes to hide in the posterior, superior and lateral portions of the breast, which are the hardest spots to include on the mammogram. That is why the technologist pushes and pulls as much tissue on the imaging plate as possible.
The other difficult part of a mammogram is the compression.
We all wonder why the technologist has to squeeze so hard. The reason is that the radiologists make them!
Motion is an enemy when it comes to mammograms. This is why the technologist has you hold your breath the moment the picture is taken. Tiny micro-calcifications and motion do not mix. The motion on the image may hide the calcifications so the radiologist is unable to see them.
“Mammograms are read by human beings, and, unfortunately, human beings aren’t perfect, so there will be false readings,” Dr. Tewfik said. “But if you, the radiologist and technologist work together, false readings can be brought down to practically nothing.”
If you have breast implants or are thinking about enhancing your breasts in the future, save this post and follow Dr. Tewfik’s very important advice.