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Medical Author:

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

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Medical Editor:

Charles Patrick Davis, MD, PhD

Charles Patrick Davis, MD, PhD

Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.

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The mammogram is quick and easy and takes only a few seconds.

• You will be asked to remove all clothing above the waist including jewelry and metal objects from around the neck.
• Then you will simply stand in front of an X-ray machine. The radiology technician places the breast between two plastic plates. The plates lightly press the breast and make it flat just enough so breast tissue can best be seen on the mammogram. This compression may be uncomfortable for a few seconds, but it helps to improve the quality of the mammographic image. Pressing the breasts for a few seconds is not harmful and minimizes the necessary X-ray dose.
• The technician will take two X-rays of each breast (and reposition you) for a complete view of the entire gland. Each breast has a double scan. In the craniocaudal projection, the X-rays beam from above toward the radiologic film positioned under the breast. In the mediolateral projection, X-rays come from the inner side toward the outside of the breast.

Women without a history of breast problems usually have a screening mammogram performed. For women with a history of breast problems, a targeted mammogram may be performed to better evaluate a particular area of the breast. Sometimes special mammograms may be requested by your doctor.

• Ductogram: If additional views are needed for specific reasons, such as bloody discharge from the nipple, the doctor may request a ductogram. It consists of mammography performed after a fine plastic tube is placed into the opening of the duct into the nipple and administration of a small amount of dye.
• Pneumocystography: This mammography is performed after a cyst is emptied with fine-needle aspiration and core biopsy, usually after the cyst has been seen on an ultrasound or if the cyst can be felt.
• Stereotactic mammography: Based on mammograms taken from two angles, a computerized map shows the precise location of masses or calcifications. This technique allows, after local anesthesia, a metallic wire with a little hook at the end to be inserted into a breast lump that cannot be felt. The wire then guides the surgeon during surgery to remove the tumor and the surrounding healthy tissue completely. After removal, a new film of the breast is taken to ensure that all the suspicious tissue has been removed. However, a stereotactic biopsy may be performed in which a small computer-controlled system guides the placement of a needle into the lesion or lump for sampling in a laboratory.
  • Two instruments have been developed to obtain stereotactic breast biopsies: the mammotome and the advanced breast biopsy instrument (ABBI). Both instruments use a rotating knife that cuts the tissue samples from the rest of the breast. Each type of biopsy has distinct advantages and disadvantages, but their accuracy is similar if well performed.

Other procedures are in limited use and some are undergoing clinical trials. These mammography procedures are used to improve the diagnostic accuracy of mammograms and are as follows: 3D mammography, digital mammography (this is the currently preferred method), MRI mammography, positron emission tomography (PET scan mammography), and diffuse optical tomography (light instead of X-rays produce the mammogram). Each specialized test has advantages and disadvantages; the radiologist who does the test can explain the need for such a new test.

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