The health of a woman's breast is vital to her overall self-esteem and body self-image. Breast self-exams should be done monthly on all women regardless of age, to palpate a possible lump, bump or mass within the different quadrants of the breast. The American Breast Cancer Society will have specific notes to the details of how to do a self-breast examination. Once again, this should be done monthly by all women. This is our first line defense in screening for malignancies or premalignancies of the breast.
A mammography should be performed on women 40 years of age or over, although the criteria is now controversial, fifty years of age has been considered the new cutoff. I still believe 40 years of age is a more realistic timeline in that it will reduce incidents of misdiagnosis of breast cancers and save many lives in the future.
Patients undergoing augmentation mammoplasty procedure, breast lifting and breast reduction surgeries should undergo preoperative screening mammography at the age of 35. Every two years after, repeated mammograms should be performed in order to detect any changes of the breast once again for suspicious lesions or abnormalities within the breast tissue. Patients who have a suspicious mass should undergo ultrasound and if that is not definitive, MRI and/or biopsy test with a radiologist, including fine needle aspiration, true core biopsy or direct excisional biopsy by a Board Certified General Surgeon. Tissue biopsies should be sent to Board Certified Pathologists for tissue diagnosis in order to determine a definitive diagnosis of the breast lesion. MRIs are extraordinarily useful. Since the re-approval of silicone gel implants in 2007, recommendations are that MRIs be performed three years after introduction of silicone gel implants for either cosmetic or reconstructive surgery and every two years thereafter. Ruptured silicone implants are very difficult to detect on mammography or clinically in that they are referred to as soft ruptures. Implant integrity of the shell may be broken. This is referred to as a Macready sign, easily identified on MRIs. Please see examples of mammograms as well as MRIs.