Guidelines for screening mammograms with breast implants

Public Health England recently published new guidelines for performing mammography on clients with breast implants, and now they recommend that the Eklund technique, or ‘implant displacement’ is offered to everyone. What do we think about that? And, for those joining us who aren’t trained in the art and science that is mammography, what the heck is it? And why do we need it? 

Why do we need the Eklund Technique?

Attribution: © Nevit Dilmen

Attribution: © Nevit Dilmen

We need it because breast implants can hide breast tissue on a mammogram. So, here’s how breasts look on a mammogram: breasts are made up of fat and glandular tissue mostly. The glandular tissue is the milk-producing tissue, and is whiter than the grey fatty tissue. Notice anything about the pattern of fatty and glandular tissue? Yes, it’s vaguely symmetrical – just like certain other things in a human, left and right are a mirror image of each other.

 

 

An image of a mammogram with breast implants

https://www.gov.uk/topic/population-screening-programmes/breast

 

 

Now here’s what breast implants look like on a mammogram. The x-rays can’t get through the implants to the detector, or as I sometimes call it, ‘the x-ray plate’, (yes, that’s what they called it in the nineteenth century, whaddya mean, it’s the twenty-first?!). So, because the x-rays can’t get through, there’s a big white space there.

Crucially, all the breast tissue on top of, and underneath, the breast implant also cannot be seen on the image.

This means, if we can’t see the breast tissue, then we can’t see any problems within that breast tissue. And there is your issue. Another issue with the augmented breast (fancy medical name alert: that just means a breast with an implant in it) is that we can’t compress the breast.

 

 

 

Breast Implants and compression

Huzzah! No squashing? Great! Well, yes and no. Great, in that, the implant is NOT compressed and possibly damaged, and that any discomfort is very minimal. However, not great, in that we can’t get a good image of the breast tissue without compression. The squash acts to ‘spread out’ the internal structures of the breast so that they aren’t overlapping one another, so that we can see everything clearly. It holds it very still too, so that we get a nice sharp, unblurred image. So, when we take a mammogram without the compression, there’s too much overlap, and it isn’t as clear as it could be.

Add to it the implant shadow problem, and we can see why mammograms of the augmented breast are a little trickier to read, as well as to perform. How do we remove this problem? Well, we can’t – not really. We can, however, modify our technique a little to try and see a bit more.

What Public Health England are recommending

The mammogram view that is recommended by the Public Health England guidelines is the Eklund technique. It is named after the Professor of Radiology who first described it in 1988, in an article here, and it involves manipulating the breast tissue so that the implant is pushed back away from the nipple towards the ribcage. The breast tissue at the front is now put under compression, so that we can see more of it as we normally would without the implant.

These images from the guidelines show the technique much better than I can describe it:

https://phescreening.blog.gov.uk/2017/04/12/addition-of-eklund-technique-improves-screening-for-women-with-breast-implants/

Attribution: https://phescreening.blog.gov.uk/2017/04/12/addition-of-eklund-technique-improves-screening-for-women-with-breast-implants/

Say what?! That sounds like it would really hurt! Well, no – at this point I must stress that this is all done very gently indeed. If you feel that it is hurting you or your implant, then do please tell the mammographer that it is uncomfortable and they’ll work with you to find a solution.

What’s the benefit?

What’s the benefit of the Eklund technique? Better visualisation of the breast tissue, more of the breast tissue is seen and thus we get more chance to see any problems within that breast tissue. Problem almost solved.

What if the Eklund technique can’t be done, for whatever reason? The guidelines recommend that we do another view, in a slightly different position than the other two routine views to show a little more breast tissue – but this will still include the implant shadow, and the breast tissue will not be under compression. However, it increases the amount of breast tissue seen – and that’s the benefit.

So there are the guidelines on how we do mammograms on breast implants in the UK. What do you think? Any more questions? The WoMMeN team are happy to answer! Ask us here

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