Mammography
Mammography uses low-dose X-ray to image breast tissue. Standard 2D mammography captures mediolateral oblique (MLO) and craniocaudal (CC) views of each breast. 3D mammography (digital breast tomosynthesis, DBT) takes multiple images at different angles to reconstruct a 3D view, improving detection rates in dense tissue and reducing false-positive recall rates. Mammography is the primary breast cancer screening tool, detecting approximately 80–90% of cancers in fatty breasts and 50–60% in dense breasts.
Ultrasound
Breast ultrasound uses high-frequency sound waves to image soft tissue. It is excellent for distinguishing fluid-filled cysts from solid masses, evaluating palpable findings, and supplemental screening in dense breasts or augmented patients. It does not use radiation, making it safe for all patients. Limitations include operator-dependence, difficulty imaging deep structures, and higher false-positive rates than mammography. Automated whole-breast ultrasound (ABUS) reduces operator-dependence and is increasingly used for supplemental screening.
MRI
Breast MRI uses magnetic fields and radio waves with gadolinium contrast to image breast tissue. It has the highest sensitivity of all breast imaging modalities (90%+) and is the preferred tool for: screening high-risk women (BRCA mutation carriers), evaluating extent of known cancer, detecting implant rupture, and post-treatment surveillance. Its limitations include high cost, limited availability, need for IV contrast, and high false-positive rates requiring biopsy for confirmation.
Imaging Augmented Breasts
Implant-displaced (ID) mammography views are standard for augmented patients — the implant is pushed posteriorly to image the natural tissue. The FDA recommends MRI every 5–6 years for silicone implant surveillance. Ultrasound can detect implant shell abnormalities but is less reliable than MRI for silent rupture. Radiologists experienced in augmented breast imaging are essential for accurate interpretation.
