MRI (Magnetic Resonance Imaging)

I have annual breast MRI because I still have one natural breast and one of my original breast tumors was only discovered on MRI. My most recent breast MRI noted that there is residual breast tissue in the implant side. For this very reason I would say that yes, you should have annual breast MRI, both to check the integrity of the implant and to check for further malignancy. Unfortunately it is usually the insurance companies placing restrictions on doing this, not he doctors or the patients. I would pay for it myself to be sure I was cancer free. This is actually a controversial area among plastic surgeons, but at the current time the official guidelines are to obtain an MRI 3 years postoperatively and then every 2 years after that. However, if there is a suspected problem with an implant, the MRI may certainly be obtained at the time of the concern. Furthermore, the official guidelines may change in the future, but your plastic surgeon should be able to keep you updated on this.

A short-term follow-up MRI is usually recommended if the radiologist saw something on the original MRI that he/she thought was most likely benign (not cancer), but wants to be more certain. If the finding doesn’t change over time, the radiologist can more confidently call it benign.

A “clogged milk duct” generally refers to a duct in the breast that looks dilated, and may have some debris within it. It is usually a benign finding, but if the radiologist is not sure why the duct is blocked, he/she may choose to either biopsy it or follow it depending on how it looks on the MRI. A short-term follow-up MRI is usually recommended if the radiologist saw something on the original MRI that he/she thought was most likely benign (not cancer), but wants to be more certain. If the finding doesn’t change over time, the radiologist can more confidently call it benign.

A “clogged milk duct” generally refers to a duct in the breast that looks dilated, and may have some debris within it. It is usually a benign finding, but if the radiologist is not sure why the duct is blocked, he/she may choose to either biopsy it or follow it depending on how it looks on the MRI.

Let’s go to the source of that information for the best answer……

This is from the product insert data sheet included with Mentor Corporation Memory Gel Implants……………..

“Rupture of a silicone gel-filled breast implant is most often silent (i.e., there are no symptoms experienced by the patient and no physical sign of changes with the implant) rather than symptomatic. Therefore, you should advise your patient that she will need to have regular MRIs over her lifetime to screen for silent rupture even if she is having no problems. The first MRI should be performed at 3 years postoperatively, then every 2 years, thereafter. The importance of these MRI evaluations should be emphasized. If rupture is noted on MRI, then you should advise your patient to have her implant removed. You should provide her with a list of MRI facilities in her area that have at least a 1.5 Tesla magnet, a dedicated breast coil, and a radiologist experienced with breast implant MRI films for signs of rupture.”

You can read the entire product insert data sheet here: http://www.mentorwwllc.com/Documents/gel-PIDS.pdf

James E. Craigie, M.D. Let’s go to the source of that information for the best answer……

This is from the product insert data sheet included with Mentor Corporation Memory Gel Implants……………..

“Rupture of a silicone gel-filled breast implant is most often silent (i.e., there are no symptoms experienced by the patient and no physical sign of changes with the implant) rather than symptomatic. Therefore, you should advise your patient that she will need to have regular MRIs over her lifetime to screen for silent rupture even if she is having no problems. The first MRI should be performed at 3 years postoperatively, then every 2 years, thereafter. The importance of these MRI evaluations should be emphasized. If rupture is noted on MRI, then you should advise your patient to have her implant removed. You should provide her with a list of MRI facilities in her area that have at least a 1.5 Tesla magnet, a dedicated breast coil, and a radiologist experienced with breast implant MRI films for signs of rupture.”

You can read the entire product insert data sheet here: http://www.mentorwwllc.com/Documents/gel-PIDS.pdf

James E. Craigie, M.D.

MRI is useful when someone is diagnosed with breast cancer. Before performing surgery we must confirm that there are no other lesions either in the same breast or the opposite breast. Sometimes tumors can be what we call "multifocal". MRI has been shown to be more sensitive than mammography for this purpose. Many people also recommend MRI for women who have a strong family history or who test positive for the gene. Several studies have shown MRI to be more sensitive than either mammography or ultrasound. It is not always specific however, so there will frequently be biopsies that are negative. MRI can be helpful as a "problem solver" when other tests have been inconclusive. MRI is useful when someone is diagnosed with breast cancer. Before performing surgery we must confirm that there are no other lesions either in the same breast or the opposite breast. Sometimes tumors can be what we call "multifocal". MRI has been shown to be more sensitive than mammography for this purpose. Many people also recommend MRI for women who have a strong family history or who test positive for the gene. Several studies have shown MRI to be more sensitive than either mammography or ultrasound. It is not always specific however, so there will frequently be biopsies that are negative. MRI can be helpful as a "problem solver" when other tests have been inconclusive.

First, to clarify, I am NOT an MD or a clinician, I am a PhD and my area of expertise is in cancer biology. That being said, there are several different methods, in addition to mammography, that can be used to screen for breast cancer.
1. Ultrasound- Ultrasound is the use of high frequency sound waves that 'bounce' off of internal structures and can provide a picture of the inside of a breast.
2. Elastography- This is a variant of ultrasound in which two different images are obtained. The breast is imaged in the normal way and is then re-imaged while it is being compressed (squashed). The idea behind this is that normal breast tissue will easily squash down but cancers are hard and do not change shape when the breast is flattened out. When the two images are compared, areas can be identified that failed to flatten out.
3. Breast MRI-Magnetic resonance imaging uses a strong magnet to alter the properties of the water in the tissue being examined (breast tissue in this case) to create an image of the breast.

If any of the methods above lead to the suspicion of cancer, a biopsy can be performed to determine if cancer is present. Note that NO medical test is perfect and it is important to understand the limitations of the tests (see below).

Learn more about cancer detection and diagnosis methods on the CancerQuest website: http://www.cancerquest.org/cancer-detection-diagnosis. Videos are also available about medical testing. First, to clarify, I am NOT an MD or a clinician, I am a PhD and my area of expertise is in cancer biology. That being said, there are several different methods, in addition to mammography, that can be used to screen for breast cancer.
1. Ultrasound- Ultrasound is the use of high frequency sound waves that 'bounce' off of internal structures and can provide a picture of the inside of a breast.
2. Elastography- This is a variant of ultrasound in which two different images are obtained. The breast is imaged in the normal way and is then re-imaged while it is being compressed (squashed). The idea behind this is that normal breast tissue will easily squash down but cancers are hard and do not change shape when the breast is flattened out. When the two images are compared, areas can be identified that failed to flatten out.
3. Breast MRI-Magnetic resonance imaging uses a strong magnet to alter the properties of the water in the tissue being examined (breast tissue in this case) to create an image of the breast.

If any of the methods above lead to the suspicion of cancer, a biopsy can be performed to determine if cancer is present. Note that NO medical test is perfect and it is important to understand the limitations of the tests (see below).

Learn more about cancer detection and diagnosis methods on the CancerQuest website: http://www.cancerquest.org/cancer-detection-diagnosis. Videos are also available about medical testing.

Despite recent claims, there is no 3D imaging yet available. Tomosynthesis (aka “tomo”) is about "2.5D" looking at the breast in a 270 degree arc but not 360 degrees. Tomo requires about 8 films and does require compression. It does give a better look at the markedly dense breast. It should not become the "routine screening" for all women. At UMass Memorial, we have been awarded a federal grant along with four other centers in the United States to build and pilot CT scanning for the breast. Our initial work with a home built unit and mastectomy specimens was highly successful leading to the grant award. CT scanning is truly 3D with 360 degree views without compression, faster times and more views. Radiation exposure should be equivalent to Tomo. We have raised over $500,000 to build and install our breast CT unit within the year. Again as with tomo, breast CT is not at this time meant for routine screening. Despite recent claims, there is no 3D imaging yet available. Tomosynthesis (aka “tomo”) is about "2.5D" looking at the breast in a 270 degree arc but not 360 degrees. Tomo requires about 8 films and does require compression. It does give a better look at the markedly dense breast. It should not become the "routine screening" for all women. At UMass Memorial, we have been awarded a federal grant along with four other centers in the United States to build and pilot CT scanning for the breast. Our initial work with a home built unit and mastectomy specimens was highly successful leading to the grant award. CT scanning is truly 3D with 360 degree views without compression, faster times and more views. Radiation exposure should be equivalent to Tomo. We have raised over $500,000 to build and install our breast CT unit within the year. Again as with tomo, breast CT is not at this time meant for routine screening.

My 3rd primary breast cancer was found by MRI in 2009. I'd had one in 2008 and it was clear. On the 2009 MRI a distinct but small area was all lit up. The tumor was small and would never have been found that early if I hadn't had the MRI. It was very hard to locate via ultrasound when I went in for the biopsy. That MRI saved my life. Yes, MRI's are particularly useful in the setting of dense breast tissue and have been shown in a large Dutch trial on screenig for BRCA mutation positive patients to detect new breast cancers prior to physical exam or mammography.

The American Cancer Society recommends yearly screening mammograms and MRIs for women with an approximately 20–25% or greater lifetime risk of breast cancer, including women with a strong family history of breast or ovarian cancer. (http://caonline.amcancersoc.org/cgi/content/full/57/2/75)

When you speak to your physician about this, it is important that you understand the benefits, limitations, and harms of different screening strategies and the degree of uncertainty about each. You may also want to speak to your physician about ultrasound as an option.

Since you have such a strong family history of breast cancer, if you haven't already, you may want to consider genetic testing for BRCA-1 and BRCA-2. This may impact some of the treatment decisions you make in the future.
The American Cancer Society recommends yearly screening mammograms and MRIs for women with an approximately 20–25% or greater lifetime risk of breast cancer, including women with a strong family history of breast or ovarian cancer. (http://caonline.amcancersoc.org/cgi/content/full/57/2/75)

When you speak to your physician about this, it is important that you understand the benefits, limitations, and harms of different screening strategies and the degree of uncertainty about each. You may also want to speak to your physician about ultrasound as an option.

Since you have such a strong family history of breast cancer, if you haven't already, you may want to consider genetic testing for BRCA-1 and BRCA-2. This may impact some of the treatment decisions you make in the future.