Who Still Gets Mammograms after Breast Surgery?

Male radiographer sat at light box studying mammograms

Six years ago during a visit to my breast surgeon following my surgery, I half asked, half stated, “No more mammograms, right?” She smiled and answered, “No breasts, no mammograms.” I thought about that for a moment, then asked, “What kind of annual screening do I get?  Do I get an MRI?” She answered, “Nope; you see me for a checkup every six months for the first two years, and once a year after that. If I see or feel something, I will refer you for additional tests, which might include an MRI.” I still was not satisfied; I needed to know exactly what this checkup would entail. My surgeon is a patient woman; she gave the full rundown on what I could expect.

“I will do a physical check of the entire area where your breasts used to be, your scar area, adjacent areas and your armpits,” she said. “It will only take a few minutes.” She was right. I’ve had several of these exams, and they only take a few painless minutes.

Then doctor explained that if a woman had a total, or a modified radical, or a radical mastectomy that included the removal of all breast tissue, and the nipple and areola, she would not need an annual routine mammogram of the affected side, but only the remaining breast. If however, she had a mastectomy removing breast tissue, but leaving the nipple and areola intact, she would still need to continue to have an annual mammogram of the breast that had the cancer, as well as the unaffected breast. Leaving the nipple and the areola following a mastectomy leaves enough breast tissue to warrant annual mammograms.

Since I had chosen not to have reconstruction, I could understand how any lumps or bumps could be easily seen or felt on me, but what about women who had reconstruction; how were they screened for a recurrence or a second primary in the same breast that had the cancer?

My doctor shared that an annual mammogram is rarely done on a breast reconstructed with implants, tissue or a combination of the two. Breast tissue has been removed, and the mammogram cannot view the underlying tissue behind the implant. However, if a clinical breast exam reveals a possible concern, a mammogram may be done with additional views.

Having a mammogram is not usually necessary following a tissue reconstruction using a woman’s own tissue from another part of her body, most often from her abdomen or back, to recreate her breast.  Some circumstances that might indicate the need for a mammogram include: women at high risk for recurrence, women with very large breasts or breasts that are difficult to examine, and any woman with a breast abnormality.

I remembered back to my first breast cancer, 10 years earlier. I had a lumpectomy and 36 external beam radiation treatments. My first mammogram of both breasts was six months after surgery, and completion of my radiation treatment. During the mammography, there was no more discomfort in the breast that had the cancer than before the lumpectomy surgery.

The problems I experienced with mammograms after my lumpectomy, came from the changes in my breast tissue as a result of radiation treatment. Changes can show up on a mammogram, making it harder to read. Several mammograms, over the 10 years between my two primary cancers, picked up things that had to be checked out through additional tests, including: ultrasound, fine-needle aspiration, and surgical biopsy. All tests were negative for breast cancer, but caused anxiety and discomfort.

Whatever her surgery for breast cancer, whether or not a woman needs an annual mammogram, she still needs to be followed by her surgeon, radiation and/or medical oncologist regularly.

Jean Campbell is a 2x breast cancer survivor and the former founding director of the American Cancer Society New York City Patient Navigator Program in 14 public and private hospitals.She is executive director of a nonprofit organization providing research and resource information and support to women and men newly diagnosed with breast cancer.

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