Breast Cancer Surveillance After Mastectomy Or Breast Reconstruction

If you’ve had a mastectomy followed by reconstruction, should you continue having mammograms? The answer is generally no, but maybe, depending on your circumstances.

 Mammograms are recommended to detect early  breast cancers; since almost all breast tissue is removed during mastectomy, mammograms are no longer required. Breast reconstruction doesn’t affect breast cancer recurrence or new tumors, so it doesn’t influence whether or not you should have continuing mammograms. Your mastectomy, however, does. The American Cancer Society recommends that “women who have had total, modified radical, or radical mastectomy for breast cancer need no further routine screening mammograms of the affect side (or sides, if both breasts are removed).”

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Annual mammograms are advised for women who:

• have unilateral mastectomy--routine mammograms are recommended on the healthy breast.
  
• had a subcutaneous mastectomy (an outdated type of nipple-sparing mastectomy that left breast tissue at the base of the nipple).

In some cases, your physician may recommend post-mastectomy imaging:

• a baseline mammogram after breast reconstruction so an unusual area that develops can be scanned and compared.
  
• a mammogram, ultrasound or needle biopsy to determine whether a lump in your reconstructed breast is scar tissue, necrosis (a hardened area where fat cells have died), or something more suspicious. 
  
• periodic mammograms or MRIs if you have an inherited BRCA mutation or a strong family history of breast cancer that puts you at high risk for recurrence (the value of mammograms and MRIs in this case hasn’t been proven, but some physicians do recommend extra surveillance for high-risk women). 

Breast reconstruction with silicone implants is an exception to the screening-after-mastectomy rule, but it is meant to check for possible “silent ruptures,” rather than detect breast tumors. The FDA recommends MRI screening of silicone implants 3 years after silicone implants are placed in the chest, and every 2 years following, for as long as the implants remain in place. (This isn’t recommended for saline implants, which deflate when they leak or rupture.) Insurance doesn’t usually pay for these MRI screenings, but they are important, since a ruptured silicone implant may not cause any visible symptoms.

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After mastectomy with or without reconstruction, you should continue to monitor your breasts with monthly self-exams and an annual clinical exam by a health care professional.

By Kathy Steligo
Reposted from Breast Reconstruction: Your Choice