When one combines the number of elective breast augmentations performed and the incidence of breast cancer occurrence, it is no surprise that the two would intersect. While ultrasound and mammography are excellent breast cancer screening tools they are not perfect and not every tumor will be detected. Magnetic resonance imaging (MRI) is a well known ‘higher level’ breast imaging modality as it is better at detecting soft tissues due to its higher spatial resolution. Since a breast implant compresses the surrounding breast tissues, MRI can be argued to be a better tumor detector.
In the May 2015 issue of the American Journal of Roetgenology a paper was published entitled ‘ Breast Carcinoma in Augmented Breasts MRI Findings’. This study was done to study the MRI characteristics of biopsy-proven breast cancers in women with breast implants using 54 patients from a ten year period. The average age of the patients was almost 50 and the patients had their breast implants in place for an average of ten years when the diagnosis was made. Of the 54 breast cancers, the mean tumor size was almost 3 cms and were located behind the muscle in the vast majority of the patients. Twenty of 54 (37%) carcinomas spread alongside the implant, 13 (24%) bordered the pectoralis major muscle, and 2 (4%) invaded the pectoralis major muscle. Of the tumors bordering the implant, 90% spread along the implant capsule and this pattern was more common in women who had received retroglandular implants (56%) than retropectoral implants (24%). MRI was able to reveal a greater extent of disease than that seen on ultrasound or mammography in 21 of 52 patients (40%). Additionally, MRI revealed previously unsuspected carcinoma in the contralateral breast in 3 of 54 cases (6%).
This study showed that breast cancers often contacted the implant or the pectoralis major muscle with growth abutting the implant more frequently in breasts in which the implants were in the subglandular position than in the submuscular position. MRIs were also able to detect a greater extent of breast cancer than mammography or ultrasound in almost half the patients studied. 40% of cases. However, an MRI is still not a great screening technique since it detected only 1/3 of the primary cancers.
MRIs are very good at detecting silicone breast implant ruptures and determining the location and extent of breast cancers.
Dr. Barry Eppley
Indianapolis, Indiana