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Breast implants and heart disease screening

patient and doctor

A woman contemplating breast implants has a lot to think about. She will likely consider the risk of surgery, weigh the pros and cons of silicone vs. saline, and make decisions regarding the size and shape of her breasts.

But is there more to consider in light of a new study advising that breast implants could impede a doctor's ability to properly diagnose a heart attack.

Srinivas Yallapragada, MD, interventional cardiologist on the Methodist Dallas medical staff, walks us through the facts.

Do breast implants get in the way of heart disease screening?

A recent study suggests breast implants interfere with electrocardiogram or ECG (also known as EKG) tests because they may act as a barrier between the heart's electrical activity and ECG electrodes.

An ECG is one of the simplest and quickest tests used to measure and interpret the heart's electrical activity. A doctor may order the test to look for the cause of chest pain, record irregular heartbeats, or help evaluate overall heart health.

Researchers with the European Society of Cardiology analyzed ECG results of 48 healthy women, some with implants and some without. While only one woman's ECG reading was considered abnormal in the control group, close to 50% of the women with breast implants had abnormal ECG results.

The small trial concluded a woman with implants could be misdiagnosed with a heart attack.

Dr. Yallapragada says it's not something he sees in his practice. Even if a patient with breast implants has an abnormal ECG result, Dr. Yallapragada says doctors would examine other factors including patient symptoms, overall health, and family history before considering a heart attack diagnosis.

When doctors are trying to make speedy diagnosis during a suspected heart attack, Dr. Yallapragada says additional tests help doctors confirm if the patient is actually experiencing one.

"There can be false positives, but we do more testing. If the patient is young and has no symptoms, I would have a tough time going further with that," he adds.

In short, Dr. Yallapragada says patients should make their doctor aware of implants before any tests, but they shouldn't worry about a false heart attack diagnosis.

Breast Implants and Implanted Defibrillators

For women with a family history of heart disease, should breast implants even be considered? What if a pacemaker or other implantable defibrillator has to be inserted in the chest to normalize the heart rhythm? Could it harm a breast implant or cause other complications?

Dr. Yallapragada says a complication would be rare. He points out that defibrillators are positioned away from breast implants, minimizing the puncture risk. The battery is inserted just under the skin in the upper chest and the defibrillator's lead wires connect directly to the heart.

In some cases, however, doctors have to work around large breast implants.

"Defibrillators and pacemakers sit under the skin in a pocket. If the tissue is pulling because of large implants and the skin is stretched, there isn't enough room. There may be some collaboration needed with a plastic surgeon in those cases," he says.

No matter the breast implant size, it is important to make doctors aware of medical history, including breast augmentation surgery.

Could breast implants complicate care later in life?

Breast implants have become far more common over the last 30 years. While some may wonder if this aging population will see complications due to implants down the road, Dr. Yallapragada says he hasn't seen heart-related problems in his practice despite the growth in implants.

Dr. Yallapragada adds that a woman with a family history of cardiac issues wouldn't necessarily have to avoid implants. He says the small trial suggesting skewed ECG results in women with implants shouldn't be enough to deter someone from considering the surgery. A woman may decide on breast augmentation for cosmetic reasons or to reconstruct the breasts following cancer treatment. Patients with congenital heart disease who have undergone multiple surgeries may choose breast augmentation to correct asymmetry.

Women considering breast implants who are already under a cardiologist's care would require additional assessment. In terms of heart health, Dr. Yallapragada says a woman should ask if she's healthy enough for surgery and make the decision that's best for her.

Methodist Health System offers advanced cardiac care, from the diagnostic to the invasive. Learn more about the services and take our Heart Risk Assessment here.