As a Board Certified Los Angeles Plastic Surgeon, I care for a wide array of different types of breast patients. My patient population includes women who present requesting breast augmentation, breast lifting, breast reduction, and breast reconstruction. In fact, I also operate on many patients years after they have had their initial post-mastectomy breast reconstruction to “tune-up” their results for such problems as breast scarring, breast implant malposition, breast implant hardening from capsular contracture, and age-related changes to the breast. One of the most common questions that I am asked regards the indications and need for MRI (magnetic resonance imaging) in these patients.
MRI is useful for several purposes in cosmetic patients who have had silicone breast implants placed. This includes evaluation for implant shell integrity(implant rupture), as well as evaluation of the breast tissue itself when it is unable to be visualized on standard mammography.
However, the use of MRI in breast cancer patients who have already undergone mastectomy procedures (in particular bilateral mastectomy, with breast reconstruction) has been controversial. Recently, a group of breast surgeons from the Saul and Joyce Brandman Breast Cancer Center at Cedars-Sinai Medical Center reviewed just this issue (Vandewalde, et al., The American Surgeon, Vol 77, No. 2, February 2011, p180.) In this observational study, 48 patients were reviewed. Sixty-eight of 79 breast MRIs (86%) showed benign findings. Two MRIs (2%) confirmed malignancy in patients with highly suspicious physical examination findings. Three MRIs (4%) led to additional imaging tests that proved to be benign. There were no patients with local breast cancer recurrence detected by these MRI exams that were not already evident on physical examination. Three quarters of the MRIs ordered were ordered for post-operative surveillance only. Six MRIs (8%) showed residual breast tissue, although most of the reports did not comment on presence or absence of breast tissue in these patients. Ultimately, this study found inadequate evidence to support the use of MRI as a routine surveillance tool after mastectomy and reconstruction. However, more studies will likely need to be done, in particular to evaluate the use of MRI to evaluate changes in autologous tissue flaps (ie. the patients’ own tissue) used in breast reconstruction.