Improved mammographic imaging using tissue expanders for breast augmentation.

Several studies indicate that mammographic evaluation of the breast is inhibited by both submammary and submuscular implants, regardless of implant composition. Two hundred radiographs were evaluated following subpectoral placement of 25 combination gel/saline and 25 saline-filled tissue expanders. Within 3 months after augmentation, mammograms were performed using the standard and displacement techniques; patients with inflated implants were followed by a repeat displacement study (with the expander deflated). After completion of the mammogram, expanders were reinflated. Our experience demonstrates that better visualization of breast tissue may be accomplished by implant-deflated views in patients with small amounts of breast tissue, tight skin envelopes, or capsular contraction. In each of these circumstances, the displaced view failed to adequately demonstrate glandular tissue. The presence of the inflated implant impairs mammographic visualization in a number of ways, including implant opacity, impaired automatic exposure control, interference with breast compressibility, and implant displacement. These effects are consistently present in small breasts (< an estimated 300 g), in breasts with grade III or IV capsular contracture, and in breasts with minimal skin laxity (i.e., nonptotic breasts). Breast compression was compromised to a greater degree in the presence of grade III and IV capsular contracture; however, deflation of an adjustable implant optimized radiographic interpretation to a high degree. The deflatable saline implant yields a less obscured evaluation of the augmented breast. We suggest that an extended-use deflatable device (i.e., tissue expander) be considered as an option in our search for a safe and reliable implant for augmentation mammoplasty, particularly in patients with small breasts, tight skin envelopes, or a propensity for capsular contracture.