A small retrospective study of breast MRI in 48 women status post bilateral mastectomy with and without reconstruction, some of whom underwent surveillance MRI, found no malignancy that was not also evident on clinical examination [33]. A retrospective study of 159 women status post bilateral mastectomy and reconstruction and undergoing MRI surveillance found no cancers in the subset of 31 women who had mastectomy performed for risk reduction [34]. Imaging after Mastectomy and Breast Reconstruction Sestamibi MBI There is no relevant literature to support the use of Tc-99m sestamibi MBI for screening in this clinical setting. US Breast There is no relevant literature to support the use of US for screening in this clinical setting. Variant 7: Female. Palpable lump or clinically significant pain on the side of the mastectomy without reconstruction. Initial imaging. Digital Breast Tomosynthesis Diagnostic There is insufficient evidence to support the use of DBT as the initial imaging modality in women with palpable lumps or clinically significant pain on the side of the mastectomy. 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. A study of 67 women who underwent mastectomy and were suspected of recurrence found 3/61 cancers detected only on mammography and not on US [16]. Another 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, diagnostic mammography yielded no additional cancers beyond those depicted on US.
Imaging after Mastectomy and Breast Reconstruction. A small retrospective study of breast MRI in 48 women status post bilateral mastectomy with and without reconstruction, some of whom underwent surveillance MRI, found no malignancy that was not also evident on clinical examination [33]. A retrospective study of 159 women status post bilateral mastectomy and reconstruction and undergoing MRI surveillance found no cancers in the subset of 31 women who had mastectomy performed for risk reduction [34]. Imaging after Mastectomy and Breast Reconstruction Sestamibi MBI There is no relevant literature to support the use of Tc-99m sestamibi MBI for screening in this clinical setting. US Breast There is no relevant literature to support the use of US for screening in this clinical setting. Variant 7: Female. Palpable lump or clinically significant pain on the side of the mastectomy without reconstruction. Initial imaging. Digital Breast Tomosynthesis Diagnostic There is insufficient evidence to support the use of DBT as the initial imaging modality in women with palpable lumps or clinically significant pain on the side of the mastectomy. 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. A study of 67 women who underwent mastectomy and were suspected of recurrence found 3/61 cancers detected only on mammography and not on US [16]. Another 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, diagnostic mammography yielded no additional cancers beyond those depicted on US.