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Mammography and Imaging After Breast Cancer Surgery

Breast self-exam (BSE) and clinical breast exam (CBE) should be routinely performed after all types of breast cancer surgery. However, the guidelines for mammography and imaging the breasts after breast cancer surgery vary, depending upon what type of surgery was performed. Screening mammography  should be continued on the unaffected breast on a yearly basis (or at an interval recommended by the patient’s physician). Annual mammograms of the unaffected breast are very important, since women who have had cancer in one breast are at higher risk of developing a new cancer of the other breast.

Mammography after Lumpectomy or Quadrantectomy

Many breast cancers can be effectively treated by lumpectomy or Quadrantectomy without removing the entire breast, especially when the breast cancer is detected at an early stage. Lumpectomy is a type of breast conserving therapy that involves the removal of a cancerous lump and a surrounding margin of normal breast tissue. Quadrantectomy is similar to a lumpectomy; a quadrant of breast tissue is removed during Quadrantectomy. Lumpectomy and quadrantectomy are usually followed by radiation therapy. In some cases, chemotherapy or hormonal therapy (i.e., with the drug tamoxifen) may also be used.

A woman who has breast conserving surgery will need to continue having routine screening mammograms of the affected breast and of the unaffected breast. Many radiologists recommend that patients have a mammogram of the treated breast (especially if the lesion has calcifications; tiny calcium deposits) immediately before and six months after the completion of radiation therapy. Radiation therapy and chemotherapy both cause changes in the skin and breast tissues that show up on the mammogram and may make the mammogram results more difficult to interpret. These changes are expected to be at their peak at six months after the radiation therapy is completed. The mammogram at this time establishes a new baseline for the affected breast for that woman. Future mammograms will be compared to this mammogram to follow healing and check for cancer recurrence.

Mammography guidelines for lumpectomy or quadrantecomy tend to vary. Many physicians recommend six month diagnostic mammograms (multiple views) of the affected breast for a period of 3-5 years and annual screening (two-view) mammography for the unaffected breast. If there is no mammographic or clinical sign of breast cancer recurrence after 3-5 years, then both breasts may be studied with routine screening (two-view) mammography at annual intervals. Each woman should consult her physician for the plan that is best for her.

Mammography After Subcutaneous Mastectomy

Subcutaneous mastectomy allows a to woman retain her natural nipples and the tissue just under the skin. After subcutaneous mastectomy, some women choose to have breast reconstruction. However, enough breast tissue often remains to require yearly screening mammography. Women who have had subcutaneous mastectomy should ask their physicians if screening mammography is necessary for their situation. Annual screening mammography is necessary on the unaffected breast.

Mammography After Simple (Total), Modified Radical, or Radical Mastectomy

A modified radical mastectomy is the most common form of breast cancer surgery used today. A modified radical mastectomy involves removing the affected breasts and often some or all of the axillary (undearm) lymph nodes. A simple or total mastectomy involves removing the affected breast but no axillary lymph nodes or muscles from beneath the chest. A radical mastectomy is an elaborate procedure in which the breast, axillary (armpit) lymph nodes and pectoral (chest wall) muscles under the breast are removed. Though radical mastectomy was once a common procedure for breast cancer patients, experts have found that modified radical mastectomy is equally effective in most cases and has become the surgery of choice.

After simple mastectomy (also called total mastectomy), modified radical mastecomy or radical mastectomy (the entire breast is removed including the nipple), many women choose to have breast reconstruction. Some women choose to have breast reconstruction using implants. Other women choose to have breast reconstruction using tissue from their own body, often from the abdominal area. Using tissue from the abdominal region to reconstruct the breast is called TRAM flap reconstruction, which stands for transverse rectus abdominus myocutaneous flap. Other women decide not to have breast reconstruction.

While some mammography centers/radiologists recommend routine imaging of the affected breast(s) after simple (total), modified radical, or radical mastectomy with or without breast reconstruction, many radiologists feel that there is little statistical evidence that imaging is effective after these surgeries. Most recurrences of cancer in the breast area (or reconstructed breast) are palpable (able to be felt) and do not require imaging for detection. If the patient has had subcutaneous mastectomy (discussed above), annual mammography is often recommended.

Some studies, including two small studies by the University of Michigan (released October 2000), show that careful screening may detect breast cancer recurrences early in women who have had TRAM flap reconstruction. However, routine mammography after mastectomy can lead to false positive abnormalities seen in the reconstructed breast that are indeterminate and lead to unnecessary biopsy (the biopsy determines that the abnormality is not cancerous).

While researchers will continue to investigate the effect of screening mammography on women who have had reconstruction, most physicians do not recommend screening mammography on women who have undergone mastectomies. Many abnormalities found in the reconstructed breast are palpable and are discovered by a physical breast exam. Physicians are not certain whether the early discovery of a recurrence of breast cancer will have any significant impact on the overall survival of the patients. However, once an abnormality is found by physical exam, physician will then order diagnostic mammography and/or other breast imaging tests. Biopsy may be performed to determine whether the abnormality is cancerous.

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Updated: June 24, 2007