Can breast implants hide breast cancer?
Yes. Implants can block part of the breast on a mammogram and make a lump harder to explain. Without the right imaging, cancer can be missed.
On a mammogram, an implant shows up as a bright shape that X rays cannot see through. Breast tissue in front of or behind it can be hidden.
Implants also bring their own lumps and changes. The body forms a layer of scar tissue around every implant. Sometimes that layer tightens and feels hard. Implants can fold, ripple, or leak. Silicone leaks can form small lumps in the tissue.
This is why a lump in a woman with implants is easy to blame on the implant. Often that is the right answer. But the implant does not make cancer less likely. A new lump still needs imaging that can tell the difference.
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Article written by Gregory Unatin, Esq. Greg is a managing partner in the law firm of Lupetin & Unatin, a medical malpractice law firm located in Pittsburgh and serving Western Pennsylvania.
Our practice is limited to high-value catastrophic cases because that is where we can do the most for our clients and for patient safety.
The following is a hypothetical situation designed to demonstrate a common form of medical error. It is not a real case, and no physician has reviewed it or offered an opinion about it.
Kim is 45 and lives near Bethlehem. She has had silicone breast implants for ten years. She feels a new lump at the edge of her left implant and sees her plastic surgeon. He thinks it is scar tissue or a leak in the implant. He orders an MRI, a scan that uses strong magnets, set up to check the implant. The implant looks intact, and Kim is told the lump is nothing to worry about.
Seven months later, the lump is bigger. She has a mammogram, an ultrasound, and a biopsy, which removes a small piece of tissue for testing. It shows breast cancer that has reached the lymph nodes, the small glands under the arm.
Kim wonders whether the lump should have been checked differently. This article can help you sort out what careful care looks like, and when a delay may support a claim.
What should happen at a mammogram if I have implants?
You should tell the imaging center about your implants, and the technologist should take extra pictures called implant displacement views. These help show the breast tissue the implant would otherwise hide.
For implant displacement views, the radiology technologist gently pushes the implant back toward the chest wall. Then the breast tissue is pulled forward in front of it for the picture. These views are added to the standard pictures. The American College of Radiology, a national group of imaging doctors, describes these views.
When the scar tissue has tightened, the implant may not move well. Implants placed under the chest muscle are often easier to move than those placed over it. When much of the tissue still cannot be seen, the report should say so.
Most imaging centers ask about implants when you schedule. Telling them helps make sure the right views are taken.
What should a doctor do about a new lump if I have implants?
A new lump or change in a breast with an implant calls for imaging that looks at the breast tissue, not only the implant. That usually means a diagnostic mammogram with implant views and an ultrasound.
A diagnostic mammogram is aimed at the problem area. An ultrasound uses sound waves to make a picture. It can show whether a lump is a fold in the implant, leaked silicone, or a solid mass in the breast. The American College of Radiology’s 2022 guide on palpable breast masses sets the first tests by age. Those tests still apply when a woman has implants.
MRI can also help. But there are two kinds of breast MRI. An MRI set up to check for a leak usually uses no contrast dye, and it is not built to look for cancer. An MRI that looks for cancer usually uses contrast dye given through a vein. A careful doctor knows which question the test is meant to answer.
If imaging shows a suspicious area, the next step is a needle biopsy. A thin needle takes small samples of tissue for testing.
What about implants after a mastectomy?
Women who had implants placed after a mastectomy, which removes the whole breast, are a separate group. Their cancer can come back in the skin, the chest wall, or the lymph nodes. A new lump on that side needs a careful look.
After a mastectomy, little breast tissue is left on that side. Routine mammograms are often not done on a rebuilt breast. Instead, the doctor checks the area by exam. A new lump, thickening, redness, or swelling near the scar or the implant should lead to an ultrasound, and sometimes an MRI or a biopsy.
Lumps after surgery are often harmless. Scar tissue and areas of damaged fat are common. But a cancer that comes back can look like those at first. Only imaging, and sometimes a biopsy, can sort them out. The other breast still needs its own screening.
Where does the chance to find it earlier get missed?
- The lump was blamed on the implant without imaging. The doctor said it was scar tissue, a fold, or a leak. No mammogram or ultrasound was ordered to check the breast tissue.
- The test answered the wrong question. An MRI set up to check for a leak showed the implant was intact. No one ordered a test aimed at cancer.
- The mammogram was done without implant views. The imaging center was not told about the implants, or the extra views were not taken. Part of the breast was never seen.
- The report said tissue was hidden, and nothing happened. The radiologist noted that the implant blocked part of the breast and suggested an ultrasound. It was never done.
- A lump after a mastectomy was called scar tissue. A new lump near the rebuilt breast was not imaged. Months passed before anyone looked again.
What should I check in my own records?
You can answer most of these from memory, your patient portal, or your records.
- When did you first report the lump or change, and to whom?
- What did the doctor say was causing it?
- Does your mammogram report mention implant displacement views?
- Did any report say part of the breast could not be seen?
- Was an ultrasound ordered? Was an MRI ordered, and was it set up to look for a leak or for cancer?
- If you had a mastectomy, who was checking the rebuilt side, and how?
- How much time passed between your first report and your biopsy?
Did the delay change the outcome?
A missed step alone is not enough for a claim. The question is whether proper imaging would likely have found the cancer at an earlier, more treatable stage.
That depends on the cancer. Breast cancers grow at different speeds. Some grow slowly over years. Others grow fast. A delay of a few months may matter a great deal for one woman and very little for another.
Medical malpractice lawyers and the experts they consult to review a case focus on a few things. They compare the size of the lump at the missed chance to its size at diagnosis. They check whether the cancer had reached the lymph nodes or other organs. They look at the type of cancer and how fast it tends to grow. And they measure the time between the missed chance and the diagnosis.
A delay can also change treatment. It may mean a larger surgery, more chemotherapy, which means strong cancer drugs, or removing the implant.
In Pennsylvania, a family does not always have to prove that an earlier diagnosis would have saved their loved one. It can be enough to show that the delay meaningfully raised the risk of harm. That added risk must also have played a real part in what happened.
When is a cancer missed with implants not malpractice?
Not every delay is malpractice. A bad outcome does not prove someone made a mistake.
- The right imaging was done and read correctly. You had a diagnostic mammogram with implant views and an ultrasound. Some cancers do not show on a mammogram or ultrasound, even when the test is done and read well. A doctor who did the right workup is not at fault just because the cancer was found later.
- The lump was checked and was from the implant. Imaging showed a fold or leaked silicone. A cancer found later in a different spot is often a separate problem.
- No lump or change was ever reported. A cancer found on routine screening, with no earlier symptoms, is often no one’s fault.
- The delay likely made no difference in prognosis or treatment. The cancer may have already spread when the lump was first reported.
What harms matter in these cases?
Our firm focuses on delays that led to death or catastrophic injury. In breast cancer cases, these are the harms that usually matter:
- Cancer that spread to distant organs, such as the bones, liver, lungs, or brain, before it was found. It can still be treated, but it can no longer be cured.
- Death from a breast cancer that, if found earlier, would likely have been curable.
What to expect when you call our office
Before we take a case, we review the records and imaging with medical experts. Pennsylvania requires a medical professional’s written statement that a claim has merit before a case can go forward. That review also helps answer whether the delay changed the outcome. A doctor, a plastic surgeon, a radiologist, an imaging center, a practice group, or a hospital system may each have played a role.
Pennsylvania has filing deadlines. For a living patient, the deadline is generally two years from a key date. That is when she knew, or should have known, that she was harmed and that medical care may have caused it. In delayed diagnosis cases, that date is often near the cancer diagnosis. After a death, claims generally must be filed within two years of the date of death. Learn more about how long you have to file a medical malpractice in Pennsylvania. For additional information on breast cancer misdiagnosis, see our main article on delayed diagnosis of breast cancer.
Frequently Asked Questions
Yes. Implants can block part of the breast on a mammogram. Extra implant views and an ultrasound help show the hidden tissue.
Extra mammogram pictures where the implant is pushed back and the breast tissue is pulled forward.
Usually not. A leak MRI often uses no contrast dye. A cancer MRI usually does.
No. A claim needs a medical error and proof that the delay likely changed the outcome or raised the risk of harm.
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Lupetin & Unatin, LLC represents Pennsylvania patients harmed by physicians who failed to meet the standard of care.