Breast MRI: How to Prepare and What to Expect

If you are scheduled to have a breast MRI, you may be wondering what to expect and if there are any preparations you should make. This guide will walk you through the MRI process, discuss why breast MRIs are used and offer tips for understanding the results of your scan.

For those looking to take proactive control of their breast health, PocketHealth can help. With secure, easy access to your breast imaging records, PocketHealth allows you to better understand your breast health. In addition, PocketHealth offers personalized estimated breast cancer risk scores to help you and your doctor make informed decisions about preventive measures and future screenings.

 

 

What is an MRI of the breast?

An MRI, short for magnetic resonance imaging, is an imaging technique that uses magnets and radio waves to create three-dimensional internal images of structures and organs. These pictures are captured on the MRI technician’s computer for the radiographer to interpret later. Because MRIs may reveal details that ultrasounds may miss, they are valuable for supplemental diagnostic and screening purposes.

 

What is a breast MRI used for?

Breast MRIs are used to create detailed images of the breast, especially for diagnosing or ruling out conditions such as cancer. Because breast MRIs provide additional and more in-depth imaging than mammograms, they can be used to screen more thoroughly for various health conditions. Here are some common reasons to have this type of scan:

• To look for or confirm breast cancer: This provides a better view of any confirmed or possible breast cancer that may have spread. It can also indicate how well breast cancer treatments are working or help detect early cancers in the first place.
• If you’re at high risk for breast cancer: MRIs can help screen for breast cancer more thoroughly. This is applicable for those with a family or personal history of the disease, including inherited gene changes in BRCA1 and BRCA2.
• If you have dense breasts: Dense breasts can affect visibility, making abnormalities easier to miss. Breast MRIs provide a more detailed look.
• For those with a history of chest radiation: Because MRIs don’t use radiation, they can be a useful way to limit exposure for patients with a history of chest radiation.
• To evaluate breast implants: This helps your doctor see if there is a tear or leak in your breast implants (when applicable). Breast MRIs can also be a good alternative to a mammogram for those with implants, as implants can impede views.

 

Breast MRI vs mammogram

Mammograms are generally more commonly performed than breast MRIs. However, there are pros and cons to both imaging techniques, which is why they are often used together when more detailed scans are necessary. Here are some common questions about how these two methods compare.

Is breast MRI better than a mammogram?

There are strengths and weaknesses to both mammograms and breast MRIs. Quite often, a mammogram will be performed first, only moving on to a breast MRI if there are abnormal results or if there is a higher risk for breast cancer. The following are some advantages of MRIs compared to mammograms:

• No radiation: This is a useful way to reduce exposure to radiation during screenings, especially if the patient has a medical history of frequent radiation for therapy or other health purposes.
• Higher sensitivity: Because of the additional detail in these scans, they can detect some tumors or growths that a mammogram may have missed.
• Earlier detection: Breast MRIs can often detect cancer before a mammogram can. This is especially relevant for those whose mammogram revealed breast cancer in one breast, while the MRI subsequently found early cancer in the other breast that wasn’t visible before.

Some benefits mammograms have over breast MRIs:

• Provides sufficient screening for most needs: Mammograms still reveal most breast conditions when screening for cancer. For those who aren’t at high risk and don’t have additional screening needs, this fast and simple scan is sufficient to evaluate breast health. 3D mammograms provide even more detail, which can benefit those requiring greater visibility.
• More affordable: Most insurances tend to cover routine screening mammograms for anyone assigned female at birth (AFAB) aged 40 to 74. In many places, you also don’t need a referral to schedule this routine appointment. While insurance policies vary and you may still have a copay or coinsurance for a mammogram, MRIs are typically much more expensive and may have limited coverage.
• Fewer false positives: Because MRIs are so sensitive, they can sometimes produce false positives, making it difficult to distinguish between early signs of breast cancer and benign breast conditions. Generally, a breast biopsy and further testing are performed to rule out disease. Frequently, these biopsies reveal no cancer, but the patient incurs the time and expense of these additional appointments.

Due to the strengths and weaknesses of both methods, doctors often recommend a mammogram for those at low risk and then perhaps a supplementary breast MRI for those at higher risk or who require more detailed imaging.

Is it common to need a breast MRI after a mammogram?

If your doctor recommends a breast MRI after you’ve had a mammogram, try not to worry. It is not uncommon to require additional imaging if abnormalities are detected or if visibility from your mammogram is limited. Even if something is found, such as a cyst or growth, these are often benign.

 

How is a breast MRI performed?

The following outlines what to expect during a typical breast MRI appointment:

1. The technician will have you remove any metallic items: Examples include jewelry and glasses. They may also ask you to change into a hospital gown if necessary.
2. Often (but not always), contrast dye is administered: This is given via IV to enhance the visibility of the images. While receiving this, you may feel cold, experience a brief headache, nausea, itching, or even a metallic taste. These side effects are usually short-lived.
3. You will be positioned on the scanning table: The MRI machine is large and tube-like, with a scanning table that slides in and out. You will lie on the table, typically face down, with your breasts positioned in a customized device called a coil that optimizes the imaging. Your arms will stay by your sides, and you’ll rest your head on a comfortable headrest.
4. You will be asked to stay still during the scan: Movement can interfere with the imaging. You will be able to hear and speak to the technician, who will be in an adjacent room where the controls are located. You may also receive an alert device to press if you need the technician for any reason.
5. During the MRI, technicians will communicate instructions: They typically inform you about what to expect and how long you’ll need to stay still for at a time. You’ll also be provided with earplugs and possibly a headset to reduce the loud noises from the MRI machine. Frequently, the headset allows you to listen to music for added comfort.
6. You may be prompted to hold your breath: This helps the technician capture the right view of the area being scanned. These intervals will be brief.
7. Once the scan is complete: The technician will slide the table back out, remove your IV, and assist you off the table. You should be able to go about your day as usual, but if you experience any lingering side effects from the contrast or other symptoms, consider communicating this before leaving.

 

How to prepare for a breast MRI

Here are some helpful ways to prepare for a breast MRI appointment.

Tips before the scan

• Consult your doctor if you experience claustrophobia: Some patients can feel a little claustrophobic in the enclosed MRI machine. If you know you’re prone to this, consider asking your doctor for a possible prescription for relaxing medication to help you through the appointment. Note that you’ll likely need to arrange a ride to and from your appointment if you take these medications.
• Let your doctor know in advance about any metallic implants: Examples include pacemakers or expander implants. Because of the magnetic nature of the MRI machine, they will want to know in advance so you can be properly accommodated.
• Inform your doctor in advance of any allergies: If you have known allergies to medications or other substances, it’s helpful for the technician to be prepared.
• Inform your doctor if you have small or hard-to-find veins: If you’re expecting contrast to be administered via IV but have a history of these vein conditions, the technician may need you to arrive early to accommodate.
• Consider bringing past breast imaging: Having copies of previous mammograms or other breast scans can be helpful to share with the radiologist for comparison. PocketHealth provides secure access to all past imaging records, instantly allowing patients to share their records with their healthcare team.
• Inform your doctor of pre-existing conditions: Specifically, if you’re pregnant, nursing or on hormone replacement therapy.

Tips during the scan

• Wear comfortable clothing: Often if you aren’t wearing any metal, such as zippers or buttons, you may be able to stay in your clothes rather than change into a medical gown. Regardless, wear something easy to take on and off if needed.
• Bring your requisition: It can be helpful to bring your MRI requisition in case the imaging facility doesn’t have it already. Also, bring your I.D. and health cards.
• Avoid wearing metal to your appointment: Ideally, you should avoid it completely, but if you have important metallic items, there will be a locker you can store them in during the scan.
• Bring extra medication patches: If you wear medication patches, there is a good chance they will have you remove it before the scan. Having an extra one allows you to have it ready after your appointment.
• Let the technician know if you’re uncomfortable: Ideally, you’ll communicate this once you’re situated on the table but before the actual scan starts. It’s important that you’re in a comfortable position where you can stay completely still. The technician may be able to adjust your positioning if you find this difficult.

 

Getting my results

The MRI technician is not legally allowed to discuss results during the scan. They can answer questions about the appointment itself, but not about the imaging results. Here are some common questions regarding getting MRI results back.

When will I get my results?

Turnaround times for MRI results can vary widely depending on the facility and your doctor’s availability. Often, patients wait a week or more and receive their results during a follow-up appointment. With PocketHealth, you don’t have to wait as long—your results are available securely as soon as they’re uploaded, allowing you to review them often before your follow-up visit.

 

 

Who interprets my results?

A radiologist—an expert in interpreting medical images—will carefully review your breast MRI and provide a detailed report of any findings. This report is then sent to your referring doctor, who, with a deeper understanding of your medical history, can offer additional insights and recommendations based on the results.

Understanding my results

Although your doctor will provide an explanation of your results, PocketHealth often allows you to access your imaging and report before your follow-up appointment. It’s common to find the medical terminology somewhat confusing, but Report Reader helps you to better understand your report by offering clear, straightforward definitions for medical terms—simply tap or click on any underlined words to reveal their meaning. Meanwhile, this guide will briefly cover common terminology found in breast MRIs.

If you’ve had a mammogram before, you may be familiar with BI-RADS, which stands for Breast Imaging Reporting and Data System. This system is used by radiologists to describe various types of diagnostic breast imaging, including breast MRIs and ultrasounds. The scale ranges from 0 to 6, with different indications for each level:

• 0 (incomplete): This means more imaging is needed. This could be because the initial breast imaging was unclear or the radiologists needed a better view of a certain area.
• 1 (negative): No abnormalities found and the breasts look symmetrical
• 2 (benign finding): This means something was found in the scan, such as a calcification or mass, but it was determined to be non-cancerous.
• 3 (probably benign finding): This means the finding has a 2% chance or less of being cancer, but repeat scanning within 6-12 months is recommended to be sure nothing changes.
• 4 (suspicious abnormality): The finding doesn’t definitively appear to be cancer, but there is a possibility it may be cancerous. A biopsy or further testing is often recommended.
• 5 (highly likely to be cancerous): The finding suggests a 95% chance or greater of being cancerous. A biopsy and additional testing are recommended.
• 6 (proven malignancy): This score applies only to individuals with confirmed cancerous findings. It is often used to assess responses to treatment.

 

Frequently asked questions

Here is a brief overview of common questions regarding breast MRIs.

How long are you in the MRI machine for a breast MRI?

Most breast MRI scans typically last 30 to 45 minutes. If contrast is administered or extra time is needed for positioning or medications, the scan may take longer.

Is a breast MRI better than a mammogram?

Breast MRIs tend to provide more detailed images than mammograms, but this increased detail can sometimes lead to false positives. This occurs when benign findings (such as growths or calcifications) are detected that were missed on the mammogram. This can result in unnecessary biopsies and testing. However, breast MRIs can sometimes identify important findings that mammograms do not detect, making them especially useful for dense breasts, which can be harder to evaluate. There are pros and cons to both methods, which is why they are often used together.

What other organs show up on a breast MRI?

In addition to the breast area, surrounding blood vessels, bones, and some of the lungs and heart will also be visible. Axillary lymph nodes in the armpits will be shown, but they may not appear as detailed as in other imaging techniques.

What does an MRI show for breast cancer?

There are several ways breast cancer can appear on an MRI, though additional testing or biopsies are usually the next steps for confirmation. Some common appearances include:

• Tumors/masses: Irregularly shaped growths may be seen, though they can also be benign and typically require a biopsy or further testing for confirmation.
• Swelling: Inflammation of the surrounding tissues could indicate a cancerous finding. Keep in mind that there are other reasons for inflammation, such as injury or infection, so try not to panic.
• Breast ductal changes: Examples include thickening or growths.
• Abnormal enhancement: This occurs when the tissue appears abnormally bright after the administration of the contrast agent. This could indicate inflammation, infection, cysts, lesions etc. Many of these could be benign or treatable. Regardless, additional testing is likely to be recommended.

What are the risks for getting a breast MRI?

Breast MRIs are considered safe and non-invasive. Risks are minimal and uncommon, though some patients may rarely experience an allergic reaction to the contrast dye. Additionally, some may feel claustrophobic during the enclosed scan.

 

Take control of your breast health journey

Given the routine nature of breast imaging, tracking changes over time is essential. Having secure access to all your imaging records in one place allows you to be actively involved in your health journey. You can compare breast changes, send records to other medical providers, and even print and store these reports for your own use. For Ruth, a breast cancer survivor, access to her past breast imaging through PocketHealth helped her reclaim her power. “For me, a lot of it is about control. I want to feel like I’m in control of my health.”

Another tool for your breast health is MyCare Navigator, which provides personalized insights to your health and identifies any recommended follow-up steps. This feature can also generate individualized questions to ask your doctor based on the findings in your report, ensuring you make the most of your consultation.