In the event of an indeterminate US finding or an US finding suggestive of fat necrosis, diagnostic mammography or DBT may be helpful for lesion characterization and may preclude the need for biopsy if a clearly benign finding such as an oil cyst is identified. Imaging after Mastectomy and Breast Reconstruction Digital Breast Tomosynthesis Diagnostic There is insufficient evidence to support the use of DBT as the initial imaging modality for women with palpable lumps or clinically significant pain on the side of the mastectomy with reconstruction. However, DBT can be useful in the diagnostic setting. It is known to improve lesion characterization in noncalcified lesions and to improve cancer detection when compared to conventional mammographic workup [36-38]. Mammography Diagnostic There is limited evidence to support the use of diagnostic mammography as the initial imaging modality in this clinical setting. Mammography may be helpful in identifying a benign postsurgical etiology of a palpable concern such as fat necrosis or oil cyst. For example, a study evaluating palpable lumps in 101 patients who had undergone mastectomy, the majority of whom (69%) had reconstruction with implants, demonstrated that mammography could be useful to confirm benign findings such as fat necrosis and benign calcifications identified on US [39]. However, the study also showed that diagnostic mammography yielded no additional cancers beyond those depicted on US. In another small study, Edeiken et al [42] found that mammography depicted only 14 of 25 (56%) of the recurrences visualized on US in women who had undergone autogenous myocutaneous flaps after mastectomy. FDG-PET Breast Dedicated There is no relevant literature to support the use of FDG-PET breast as the initial imaging modality in this clinical setting. MRI Breast Without and With IV Contrast There is insufficient evidence for MRI without and with IV contrast as the initial imaging modality in this setting.
Imaging after Mastectomy and Breast Reconstruction. In the event of an indeterminate US finding or an US finding suggestive of fat necrosis, diagnostic mammography or DBT may be helpful for lesion characterization and may preclude the need for biopsy if a clearly benign finding such as an oil cyst is identified. Imaging after Mastectomy and Breast Reconstruction Digital Breast Tomosynthesis Diagnostic There is insufficient evidence to support the use of DBT as the initial imaging modality for women with palpable lumps or clinically significant pain on the side of the mastectomy with reconstruction. However, DBT can be useful in the diagnostic setting. It is known to improve lesion characterization in noncalcified lesions and to improve cancer detection when compared to conventional mammographic workup [36-38]. Mammography Diagnostic There is limited evidence to support the use of diagnostic mammography as the initial imaging modality in this clinical setting. Mammography may be helpful in identifying a benign postsurgical etiology of a palpable concern such as fat necrosis or oil cyst. For example, a study evaluating palpable lumps in 101 patients who had undergone mastectomy, the majority of whom (69%) had reconstruction with implants, demonstrated that mammography could be useful to confirm benign findings such as fat necrosis and benign calcifications identified on US [39]. However, the study also showed that diagnostic mammography yielded no additional cancers beyond those depicted on US. In another small study, Edeiken et al [42] found that mammography depicted only 14 of 25 (56%) of the recurrences visualized on US in women who had undergone autogenous myocutaneous flaps after mastectomy. FDG-PET Breast Dedicated There is no relevant literature to support the use of FDG-PET breast as the initial imaging modality in this clinical setting. MRI Breast Without and With IV Contrast There is insufficient evidence for MRI without and with IV contrast as the initial imaging modality in this setting.