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Breast Implant Waiver

Patient advisory/Consent of mammography for patients with BREAST IMPLANTS
1. Your physician has recommended that you have a mammogram. This procedure is currently the best way to detect a cancer of the breast that cannot be detected by breast palpation.
2. Breast implants can interfere with the interpretation of your mammogram because they obscure some of the breast tissue. However, newer techniques that involve minor displacement of the implants allow for a good examination. To provide adequate displacement of the implants, it is necessary to apply pressure with the mammography machine to the breast and the implant. The pressure may uncomfortable, but it is essential to the examination.
3. While thousands of implant patients have undergone successful mammography without problems, there have been reports of an occasional rupture of the implants that may not be aware of this possibility and take the utmost care in their technique. You should be aware that there are some risk of a rupture occurring.
4. Implants that have been on place for a number of years may be more vulnerable. However, since the risk of an implant rupture is far less than the risk of breast cancer, a mammogram is necessary to protect a woman’s health.
I have read this advisory. Though I am aware of the possible risk of damage to my breast implants as a result of a mammography, I consent to the procedure. I agree to release AQ Modern Diagnostic imaging, the performing mammography technologist(s) and employees of any responsibility if a rupture should occur during this exam.