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Implants block X-ray view of the breast.

Mammography, an X-ray examination of the breast, can be a lifesaver when it comes to detecting cancer. However, cancer specialists have worried that breast implants may make it harder to find a tiny breast tumor. A new study seems to confirm that fear.

Women who undergo breast augmentation for cosmetic reasons are typically young and thus not at high risk for breast cancer, says plastic surgeon Neal Handel of The Breast Center in Van Nuys, Calif. As these women age, though, the issue of breast cancer becomes more pressing. Handel and his colleagues reported in 1988 that women who had undergone breast augmentation and who later developed breast cancer were more likely to have an advanced tumor at the time of diagnosis.

To find out more about the effects of implants on mammography, Handel and his colleagues recruited 68 women who wanted breast augmentation to improve their appearance. The team obtained a mammogram of each breast before surgery and another one about a year and a half after the women had received their silicone-gel-filled implants. All implants are radio-opaque and thus can obscure breast tissue, Handel notes. A condition called "capsular contracture" makes the problem even worse, Handel said this week at a science reporters' meeting in Marina del Rey, Calif., sponsored by the American Medical Association.

Soon after surgeons insert an implant into the breast, scar tissue forms around the capsule, Handel explains. In some women, that scar tissue contracts, making the breasts hard. Because mammography equipment compresses the breast in order to obtain a clear image of the tissue, such hardening makes the resulting picture even cloudier than a mammogram of a breast with scar tissue that remains pliable.

Indeed, the team found that women with more severe contracture showed a 50 percent reduction in the amount of tissue that showed up on the postoperative X-ray. By contrast, women with little or no contracture showed a 30 percent decline in the breast tissue that could be visualized.

These findings, which appear in the Oct. 14 JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, underscore concern that a tumor that can't be viewed on the mammogram could gain a head start and perhaps spread to other parts of the body before a diagnosis can be made.

The team also found that a certain type of mammography, called displacement mammography, provides somewhat clearer images than standard compression mammography. However, significant portions of breast tissue remain hidden even when radiologists rely on displacement mammography, Handel warns.

"Patients need to be aware that there are potential risks and complications associated with implants," Handel says. He maintains that the benefits of implant surgery can still outweigh the risks, especially for young women who have self-esteem problems caused by a flat chest.

Toni Young of the National Women's Health Network in Washington, D.C., cautions that breast implants have been associated with other health hazards, including a serious autoimmune disorder. She advises women to delay scheduling such surgery until studies determine the procedure's safety.

Finally, Handel takes a more cautious approach for women whose family history puts them at high risk of breast cancer. He says his study's findings argue against breast augmentation for these women.
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Title Annotation:tissue may not be visible in post operative tests
Author:Fackelmann, Kathy A.
Publication:Science News
Date:Oct 17, 1992
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