On 1/18/2009
rosydosy wrote:
Hi,
I had double mastectomies with silicone implant reconstruction. My surgeon had said I would never have to have a mammogram again and now he says it is recommended. I also have just had rectal cancer and have chest/abdominal CT's every 3 months. I just wonder if I really need a mammogram. Wouldn't a chest CT show something? Anyone out there with mastectomies and implant reconstruction still getting mammograms?
Appreciate your help!
RosyDosy
Hi RosyDosy,
The answer to your question largely depends on how much tissue you had removed with your double mastectomy, and if it's even physically possible to get good imaging of the tissue that remains.
I would ask your dr why they change in his recommendation on mammograms, and I would really press him on the issue - if he has learned something new since he told you you wouldn't need mammograms, then you need to know that information so you can make informed decisions.
Mammograms with implants is problematic, and special techniques are required. Even with someone trained and with the proper equipment to do mammography with implant, the implants can still cause shadows on the films that make it hard to determine what the scan is really showing. Plus there is the question of just how effective the technique is at getting all the remaining natural tissue in the picture - is difficult enough to get a good mammogram of some women, let alone dealing with the implants. Also, that's a lot of compression to put on those implants and the surrounding scar tissue.
CT scan of the chest for someone with implants is not infallible, either, but then scans are not guaranteed infallible for anyone. THe most accurate and conclusive scans can be obtained with PET/CT scans, and they are appropriate for a woman with implants. Anything that shows up on a regular CT, or a PET/CT can then be checked with scintimammography (nuclear medicine - injecting a radioactive dye that has an affinity for cancer cells, and taking pictures with a special camera - no breast compression involved.) THese procedures are expensive, but possibly quite a bit more accurate than a mammogram or regular CT of the chest, and Scintimammography is definitely more comfortable than a regular
mammogram - you lie on a table with your breasts hanging through an
opening in the table while the pictures are taken.
Don't be afraid to formulate your questions, write them down so you don't forget them, and then ask your surgeon, and don't be satisfied with an answer like, "well, I just think it's better." Also, consider getting a second opinion.
http://www.imaginis.com is a really good site for answering questions about breast cancer, implants, etc.
Sincerely,
Tre