You might have heard from someone or read online various recommendations regarding the need for MRI of your breasts every few years following the insertion of silicone breast implants such as for breast enlargement, breast lift with implants or breast reconstruction. If you recently had silicone implants placed or are considering them for cosmetic or reconstructive breast surgery, you may be wondering whether or not this is really true and definitely needed or just more unfounded, internet facilitated “information”.
Let me clarify this situation for you. Starting back in 2006 when the FDA (Federal Drug Administration) again allowed unrestricted (essentially) usage of silicone breast implants for both cosmetic and reconstructive procedures, their “recommendations” were:
Screen for silent rupture using MRI. Women with silicone gel-filled breast implants
should undergo MRI screening for silent implant ruptures at 3 years post-implantation,
and every 2 years thereafter.
Like many government edicts, this is not without considerable financial consequences. Many insurance companies will not authorize (cover) an MRI of the breasts for women who have no symptoms. This is even more likely if the surgery was for a breast augmentation as compared to breast reconstruction. The cost of an MRI paid out of pocket for those with no insurance coverage can range from over $500 to in excess of $2000.
You are surely thinking: “Do I really need to have MRI of my breasts regularly?” as well as the expected: “Will my insurance cover this because, if not, I can’t afford to have them done as they are too expensive?”
Is there evidence to support this recommendation/edict by the FDA?
In short, the answer is NO.
Clinical research conducted by plastic surgeons at Memorial Sloan-Kettering Cancer Center in New York and published in the Plastic and Reconstructive Surgery journal clearly does not support this recommendation. They note that there is no conclusive evidence that screening MRI results in a reduction in patient morbidity or that the benefits of interval screening outweigh the risks which do include false positive results that can lead to unnecessary surgery. From my personal experience, I have had several asymptomatic patients (all breast reconstruction) whose MRI at 5 years indicated a ruptured implant leading to surgery whereupon the implants were found to be entirely intact and pristine (a false positive reading).
Evidence and experience supports the approach of obtaining MRI during the first 10 years after implantation only when the patient is experiencing certain symptoms or physical findings. Ultimately, it may be a judgment call on the part of the plastic surgeon or other physician in determining the prudence and necessity of obtaining a MRI particularly when it is not covered by insurance.
Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona