Q : Dr. Eppley, I have had silicone gel implants for 31 years and am still very pleased with them. I am presently 65 years old and in good health. I regularly had mammograms every two years until five years ago. At that time, the place where got my mammograms asked me to sign a disclosure form stating that I would not hold the clinic or technicians responsible if one or both of my implants as a result of the test. This was alarming to me and I walked away without the mammogram and have not had one since!
I realize that foregoing mammograms is foolish. My doctor encourages me to have it done even though I have shared my fear. Is there a better way to examine the breast with silicone implants other than a mammogram? My breasts are small and when the paddle compresses them, it does feel like the implants could burst especially since they are such old implants. How do we know that the bag that encloses the silicone will not leak or burst? I’ve also had an ultrasound but they said that is not a good substitute and will not detect cancer cells.
Dr. Eppley, if you have any suggestions or answers to these concerns, I would certainly appreciate hearing from you.
A: Your fears about rupture of breast implants with mammograms is understandable, particularly in light of their age. While today’s breast implants have improved shells (the bag containing the implant filler) that are known to be resistant to the compressive forces of mammograms, the physical characteristics of implants thirty years ago are undoubtably less so.
I have seen breast implants of this age before on removal and most of them are either ruptured or no longer have any identifiable shell remaining. (meaning it has completely disintegrated)At thirty-one years of age, it is very likely that your breast implants are already ruptured or the shell is no longer intact. Even in asymptomatic, capsular contracture-free breasts, old breast implants will often, if not usually, not be intact.
That being said, I think your concern about breast implant rupture should not outweigh the potential benefits of mammography. Mammograms are still the simplest and most cost-effective screening tool that exists for breast cancer detection. An MRI of the breast can be done but it is more sensitive to look at whether breast implant rupture exists than to detect breast cancer.
Dr. Barry Eppley