Why Breast Exams and Implant Care Matter More Than You Think

Whenever Dr. Killeen talks about mammograms or breast exams, there are always naysayers who claim these screenings don't decrease mortality in women with breast cancer. But mortality is not the only endpoint — and living through cancer isn't the only thing that matters.

Catching things early means:

• Less treatment — potentially no chemo, potentially no radiation
• Less invasive surgery — lumpectomy instead of mastectomy
• Better quality of life — avoiding the extensive physical and emotional toll of advanced-stage treatment

Even if a patient survives either way, shouldn't we want them to avoid all of that if possible?

There's a common argument that if something is symptomatic, doctors will catch it. But that's not screening — that's reactive care. Patients frequently don't notice things on their own. Dr. Killeen regularly sees patients with cancers found on mammography who have visible lesions they never noticed because the mass grew slowly over a couple of years. And sometimes the clinician who ordered the mammogram never even examined them.

We can't expect patients to be clinicians. Good care for women means we examine them — proactively and thoroughly.

Critics often point to the "harm" of screening — typically an unnecessary biopsy. But what about the harm of missing things? What about the chemotherapy a patient might not have needed if the cancer was caught earlier? What about the more extensive surgery? We're focused on the wrong things when we weigh a biopsy against months of avoidable treatment.

Building on the screening discussion, there's another critical gap in care: breast implants are often ignored by doctors other than plastic surgeons.

Every doctor who examines breasts should know what a normal implant exam looks like and what screening is appropriate. But this is especially important for breast surgeons who are taking patients with implants to the operating room.

Dr. Killeen regularly sees patients with breast masses — cancer or benign — who were taken to surgery with problematic, aging implants, and nothing was done to address the implant. This is a missed opportunity. When a patient is already undergoing breast surgery for a mass, it's the perfect time to also address implant issues, and insurance coverage is often easier to obtain in this setting.

This year alone, Dr. Killeen has seen multiple patients who had a lumpectomy for breast cancer followed by radiation — all while having 20+ year-old implants with capsular contractures that were never addressed. Now these patients have horrible contractures in radiated tissue, making treatment far more difficult than it needed to be.

Breast surgeons: if your patient has implants, please:

1. Find out the age of the implants
2. Assess for capsular contracture
3. Get a plastic surgeon involved so you can work together for better patient outcomes

Don't make coverage or cost decisions for your patients. Give them the information, involve the right specialists, and let the patient decide. They deserve an adequate exam, a plastic surgeon's input, and the chance to avoid living in pain with preventable problems.