“I have breast implants and am turning 40. Should I have an annual mammogram?”

September 3rd, 2008 Dr. McKane

I received an email today from a patient that writes, “I have breast implants and am turning 40.  Should I have an annual mammogram?”  She goes on in the letter to talk about her worries of causing rupture of the implant when her breast is compressed during the study.  I want to make it perfectly clear to this patient and to any woman that has breast implants that following the ACS guidelines for yearly mammograms beginning at age 40 is absolutely critical.  Yes, absolutely have your annual mammogram; it could save your life! 

Let me go into this a little further.  Breast augmentation is the most commonly performed plastic surgical procedure in the United States.  Approximately 300,000 cases were performed last year alone.  If one in every 8 women is expected to develop breast cancer in her lifetime, that would mean that of this cohort, 37500 women would be expected to develop breast cancer.  This is a huge number and breast cancer screening is critical to these women.   While it is true that breast augmentation decreases the sensitivity of mammograms, this does not seem to impact prognosis or survival rates.  I am aware of 3 studies that have evaluated this issue and all 3 concluded that mammography should be used for augmented patients at appropriate intervals as part of a woman’s screening for breast cancer.  At this point in time, other screening methods are not recommended, although ultrasonography may become an increasingly important modality in augmented women with very dense breasts.    What is important, however, is that an augmented woman that is planning to undergo mammography should have the study performed by clinicians who are trained in implant imaging. 

Here are the current recommendations of the American Cancer Society and this table and additional information can be found at their website www.cancer.org:

What Has Changed and Why
	Former guidelines (1997)	Updated guidelines and information (May 2003)	Explanation
Women at average risk
Mammography	Annually starting at age 40	No change from 1997 recommendation. There is a tremendous amount of additional, credible evidence of the benefit of mammography since 1997, especially regarding women in their 40s.	Women can feel confident about the benefits associated with regular screening mammography. However, mammography also has limitations: it will miss some cancers, and it sometimes leads to follow up of findings that are not cancer, including biopsies.
CBE	Every three years for women 20-39; annually for women 40 and older	CBE should be part of a woman’s periodic health examination, about every three years for women in their 20s and 30s and annually for women 40 and older.	CBE is a complement to regular mammography screening and an opportunity for women and their health care providers to discuss changes in their breasts, risk factors, and early detection testing.
BSE	Monthly starting at age 20	Women should report any breast change promptly to their healthcare provider.Beginning in their 20s, women should be told about the benefits and limitations of BSE. It is acceptable for women to choose not to do BSE or to do it occasionally.	Research has shown that BSE plays a small role in detecting breast cancer compared with self awareness. However, doing BSE is one way for women to know how their breasts normally feel and to notice any changes.
Older women and women with serious health problems	Additional research is needed.	Continue annual mammography, regardless of age, as long as a woman does not have serious, chronic health problems. For women with serious health problems or short life expectancy, evaluate ongoing early detection testing.	There is a need to balance the potential benefits of ongoing screening mammography in women with limited longevity against the limitations. The survival benefit of a current mammogram may not be seen for several years.
Women known to be at increased risk
Women known to be at increased risk	Women with a family history of breast cancer should discuss guidelines with their doctors.	Women known to be at increased risk may benefit from earlier initiation of early detection testing and/or the addition of breast ultrasound or MRI.	The evidence available is only sufficient to offer general guidance. This guidance will help women and their doctors make more informed decisions about screening.

The abbreviations CBE represent clinical breast examinations performed by your doctor, and BSE is bilateral self examinations performed by you. 

If you worry about implant rupture with mammography, this is a risk.  But let me ask you, is the cost of replacing an implant worth your life?  I don’t think so, speak with your doctor and please follow the ACS guidelines. 

Our websites  www.beauty-surgeon.com and www.drmckane.com have  additional information and before and after photographs of breast augmentation for review.  I invite you to schedule a consultation with me if you would like to learn more about breast augmentation or breast cancer screening in augmented patients.  Please feel free to contact our office at (713) 661-5255 if you have any questions. 

-Brice W. McKane, M.D.

Posted in Breast Augmentation, Breast Cancer, Home | No Comments »

“My breast implants have dropped, what can I do?”

September 2nd, 2008 Dr. McKane

I received an email over the weekend from a woman that has undergone a breast augmentation approximately 5 months ago by another surgeon.  She noted that her implants were placed through the axillary (arm pit) approach and that her implants have fallen too low on her chest.  She writes, “My breast implants have dropped, what can I do?”

Implant malposition following breast augmentation is probably a more frequent problem than is identified in the literature.  It can be seen with any of the surgical approaches.  Malposition can be due to a technical error or it can be the result of the weight of an implant and it’s effect of stretching or dissecting the breast tissues.  It is clear that larger implants are more prone to malposition than smaller ones.  We would describe this woman’s problem with implants that are too low as “bottoming out.”  Malposition can occur in any direction, that is, implants can be positioned too high, too low, too far towards the center of the chest, or to far towards the arm.  

If conservative measures fail to improve implant malposition, there are several surgical techniques that can be used to correct the problem.  These involve using suture lines to close down a portion of the implant pocket and correct the implant’s malposition.  In the technique that I use, I also perform capsulotomies (incisions in the breast capsule) opposite the location of the suture lines  to take some of the tension off of the repair.  Patients are required to tape the breasts and to wear underwire bras for several weeks after surgery to support the repairs while they are healing. 

Here is an example of a patient that experienced implant malposition following a transaxillary breast augmentation.  She was an A cup before her initial procedure and had very short nipple to inframammary fold distances.  She had selected a sizable implant for her initial procedure.  If you consider the history of this patient, she was a set up for problems with implant malposition.  When she presented to my clinic she had “bottoming out” of her implants; that is, they were positioned too low on her chest wall.  Here is the preoperative photograph:

During our consultation she expressed a desire to use the same size implants as her initial surgery.  Her goal was to correct the low position of the implants on her chest.  I performed capsulorraphies (suture closure of the breast pocket) at the lower aspect of the breast on both sides to reconstruct the breast fold and move the implants to a higher position on the chest.  During the procedure I also performed capsulotomies opposite the suture lines at the upper aspect of the breast to take some of the tension off of the repair.  Here is the postoperative result:

The operation achieved her goal of correcting the low position of her implants through reconstructing the breast folds on both sides.  She is now very pleased with her results. 

Our websites www.beauty-surgeon.com and www.drmckane.com have additional information and before and after photographs of breast augmentation for review.  I invite you to schedule a consultation with me if you would like to learn more about breast augmentation or reconstructing implant malposition.  Please feel free to contact our office at (713) 661-5255 if you have any questions.

-Brice W. McKane, M.D.

Posted in Breast Augmentation, Correcting Problems with Breast Implants, Home | No Comments »