Breast Cancer Screening Protocol for Patients with Silicone Implants

Standard Screening Recommendations

The American College of Radiology recommends that patients with silicone implants follow the same breast cancer screening protocols as those without implants, with additional specialized imaging techniques to account for the presence of implants 1, 2
Both standard craniocaudal and mediolateral oblique views AND implant-displaced views should be obtained during mammography to maximize visualization of breast tissue 1, 3

Mammography with implant-displaced views is the primary screening modality for patients with silicone implants aged 40 and older, with a recommendation from the American College of Radiology 2, 4
Mammography can identify extracapsular silicone but cannot reliably detect intracapsular rupture, as stated by the American College of Radiology 1, 5
Comparison with prior imaging is critical, especially in patients who have had previous silicone implants, to differentiate between new rupture and residual silicone, according to the American College of Radiology 3, 5

For asymptomatic women with silicone implants under age 40, some experts recommend ultrasound as the initial screening tool, with MRI reserved for patients with abnormal sonographic findings, as suggested by the American College of Radiology 4, 6

Clinical examination alone is unreliable for detecting implant rupture, as stated by the American College of Radiology and Praxis Medical Insights 1, 7
Previous history of radiation therapy significantly increases the risk of capsular contracture, according to Praxis Medical Insights 7

Mammography cannot reliably detect intracapsular rupture, which represents the majority of implant ruptures, as noted by the American College of Radiology 1, 3
Several ultrasound intracapsular-rupture mimics exist, including reverberation artifact, radial folds, or silicone implant impurities, as reported by the American College of Radiology 3
The FDA recommendations for implant rupture evaluation do not replace additional imaging warranted based on the patient's medical history or circumstances, as stated by the American College of Radiology 1, 2