Imaging after Mastectomy and Breast Reconstruction

Variant: 1 Female. Breast cancer screening. History of cancer, mastectomy side(s), no reconstruction.

Procedure	Appropriateness Category	Relative Radiation Level
US breast	Usually Not Appropriate	O
Digital breast tomosynthesis screening	Usually Not Appropriate	☢☢
Mammography screening	Usually Not Appropriate	☢☢
MRI breast without and with IV contrast	Usually Not Appropriate	O
MRI breast without IV contrast	Usually Not Appropriate	O
FDG-PET breast dedicated	Usually Not Appropriate	☢☢☢
Sestamibi MBI	Usually Not Appropriate	☢☢☢

Variant: 2 Female. Breast cancer screening. History of cancer, autologous reconstruction side(s) with or without implant.

Procedure	Appropriateness Category	Relative Radiation Level
Digital breast tomosynthesis screening	May Be Appropriate	☢☢
Mammography screening	May Be Appropriate	☢☢
US breast	Usually Not Appropriate	O
MRI breast without and with IV contrast	Usually Not Appropriate	O
MRI breast without IV contrast	Usually Not Appropriate	O
FDG-PET breast dedicated	Usually Not Appropriate	☢☢☢
Sestamibi MBI	Usually Not Appropriate	☢☢☢

Variant: 3 Female. Breast cancer screening. History of cancer, nonautologous (implant) reconstruction sides(s).

Procedure	Appropriateness Category	Relative Radiation Level
US breast	Usually Not Appropriate	O
Digital breast tomosynthesis screening	Usually Not Appropriate	☢☢
Mammography screening	Usually Not Appropriate	☢☢
MRI breast without and with IV contrast	Usually Not Appropriate	O
MRI breast without IV contrast	Usually Not Appropriate	O
FDG-PET breast dedicated	Usually Not Appropriate	☢☢☢
Sestamibi MBI	Usually Not Appropriate	☢☢☢

Variant: 4 Female. Breast cancer screening. High-risk, bilateral prophylactic mastectomy, no reconstruction.

Procedure	Appropriateness Category	Relative Radiation Level
US breast	Usually Not Appropriate	O
Digital breast tomosynthesis screening	Usually Not Appropriate	☢☢
Mammography screening	Usually Not Appropriate	☢☢
MRI breast without and with IV contrast	Usually Not Appropriate	O
MRI breast without IV contrast	Usually Not Appropriate	O
FDG-PET breast dedicated	Usually Not Appropriate	☢☢☢
Sestamibi MBI	Usually Not Appropriate	☢☢☢

Variant: 5 Female. Breast cancer screening. High-risk, bilateral prophylactic mastectomy with autologous reconstructions.

Procedure	Appropriateness Category	Relative Radiation Level
US breast	Usually Not Appropriate	O
Digital breast tomosynthesis screening	Usually Not Appropriate	☢☢
Mammography screening	Usually Not Appropriate	☢☢
MRI breast without and with IV contrast	Usually Not Appropriate	O
MRI breast without IV contrast	Usually Not Appropriate	O
FDG-PET breast dedicated	Usually Not Appropriate	☢☢☢
Sestamibi MBI	Usually Not Appropriate	☢☢☢

Variant: 6 Female. Breast cancer screening. High-risk, bilateral prophylactic mastectomy with nonautologous (implant) reconstructions.

Procedure	Appropriateness Category	Relative Radiation Level
US breast	Usually Not Appropriate	O
Digital breast tomosynthesis screening	Usually Not Appropriate	☢☢
Mammography screening	Usually Not Appropriate	☢☢
MRI breast without and with IV contrast	Usually Not Appropriate	O
MRI breast without IV contrast	Usually Not Appropriate	O
FDG-PET breast dedicated	Usually Not Appropriate	☢☢☢
Sestamibi MBI	Usually Not Appropriate	☢☢☢

Variant: 7 Female. Palpable lump or clinically significant pain on the side of the mastectomy without reconstruction. Initial imaging.

Procedure	Appropriateness Category	Relative Radiation Level
US breast	Usually Appropriate	O
Digital breast tomosynthesis diagnostic	May Be Appropriate	☢☢
Mammography diagnostic	May Be Appropriate	☢☢
MRI breast without and with IV contrast	Usually Not Appropriate	O
MRI breast without IV contrast	Usually Not Appropriate	O
FDG-PET breast dedicated	Usually Not Appropriate	☢☢☢
Sestamibi MBI	Usually Not Appropriate	☢☢☢

Variant: 8 Female. Palpable lump or clinically significant pain on the side of the mastectomy with reconstruction (autologous or nonautologous). Initial imaging.

Procedure	Appropriateness Category	Relative Radiation Level
US breast	Usually Appropriate	O
Digital breast tomosynthesis diagnostic	May Be Appropriate	☢☢
Mammography diagnostic	May Be Appropriate	☢☢
MRI breast without and with IV contrast	Usually Not Appropriate	O
MRI breast without IV contrast	Usually Not Appropriate	O
FDG-PET breast dedicated	Usually Not Appropriate	☢☢☢
Sestamibi MBI	Usually Not Appropriate	☢☢☢

Panel Members

Summary of Literature Review

Introduction/Background

Initial Imaging Definition

Discussion of Procedures by Variant

Variant 1: Female. Breast cancer screening. History of cancer, mastectomy side(s), no reconstruction.

Variant 1: Female. Breast cancer screening. History of cancer, mastectomy side(s), no reconstruction.
A. FDG-PET Breast Dedicated

Variant 1: Female. Breast cancer screening. History of cancer, mastectomy side(s), no reconstruction.
B. Digital Breast Tomosynthesis Screening

Variant 1: Female. Breast cancer screening. History of cancer, mastectomy side(s), no reconstruction.
C. Mammography Screening

Variant 1: Female. Breast cancer screening. History of cancer, mastectomy side(s), no reconstruction.
D. MRI Breast Without IV Contrast

Variant 1: Female. Breast cancer screening. History of cancer, mastectomy side(s), no reconstruction.
E. MRI Breast Without and With IV Contrast

Variant 1: Female. Breast cancer screening. History of cancer, mastectomy side(s), no reconstruction.
F. Sestamibi MBI

Variant 1: Female. Breast cancer screening. History of cancer, mastectomy side(s), no reconstruction.
G. US Breast

Variant 2: Female. Breast cancer screening. History of cancer, autologous reconstruction side(s) with or without implant.

Variant 2: Female. Breast cancer screening. History of cancer, autologous reconstruction side(s) with or without implant.
A. FDG-PET Breast Dedicated

Variant 2: Female. Breast cancer screening. History of cancer, autologous reconstruction side(s) with or without implant.
B. Digital Breast Tomosynthesis Screening

Variant 2: Female. Breast cancer screening. History of cancer, autologous reconstruction side(s) with or without implant.
C. Mammography Screening

Variant 2: Female. Breast cancer screening. History of cancer, autologous reconstruction side(s) with or without implant.
D. MRI Breast Without IV Contrast

Variant 2: Female. Breast cancer screening. History of cancer, autologous reconstruction side(s) with or without implant.
E. MRI Breast Without and With IV Contrast

Variant 2: Female. Breast cancer screening. History of cancer, autologous reconstruction side(s) with or without implant.
F. Sestamibi MBI

Variant 2: Female. Breast cancer screening. History of cancer, autologous reconstruction side(s) with or without implant.
G. US Breast

Variant 3: Female. Breast cancer screening. History of cancer, nonautologous (implant) reconstruction sides(s).

Variant 3: Female. Breast cancer screening. History of cancer, nonautologous (implant) reconstruction sides(s).
A. Digital Breast Tomosynthesis Screening

Variant 3: Female. Breast cancer screening. History of cancer, nonautologous (implant) reconstruction sides(s).
B. Mammography Screening

Variant 3: Female. Breast cancer screening. History of cancer, nonautologous (implant) reconstruction sides(s).
C. FDG-PET Breast Dedicated

Variant 3: Female. Breast cancer screening. History of cancer, nonautologous (implant) reconstruction sides(s).
D. MRI Breast Without IV Contrast

Variant 3: Female. Breast cancer screening. History of cancer, nonautologous (implant) reconstruction sides(s).
E. MRI Breast Without and With IV Contrast

Variant 3: Female. Breast cancer screening. History of cancer, nonautologous (implant) reconstruction sides(s).
F. Sestamibi MBI

Variant 3: Female. Breast cancer screening. History of cancer, nonautologous (implant) reconstruction sides(s).
G. US Breast

Variant 4: Female. Breast cancer screening. High-risk, bilateral prophylactic mastectomy, no reconstruction.

Variant 4: Female. Breast cancer screening. High-risk, bilateral prophylactic mastectomy, no reconstruction.
A. FDG-PET Breast Dedicated

Variant 4: Female. Breast cancer screening. High-risk, bilateral prophylactic mastectomy, no reconstruction.
B. Digital Breast Tomosynthesis Screening

Variant 4: Female. Breast cancer screening. High-risk, bilateral prophylactic mastectomy, no reconstruction.
C. Mammography Screening

Variant 4: Female. Breast cancer screening. High-risk, bilateral prophylactic mastectomy, no reconstruction.
D. MRI Breast Without IV Contrast

Variant 4: Female. Breast cancer screening. High-risk, bilateral prophylactic mastectomy, no reconstruction.
E. MRI Breast Without and With IV Contrast

Variant 4: Female. Breast cancer screening. High-risk, bilateral prophylactic mastectomy, no reconstruction.
F. Sestamibi MBI

Variant 4: Female. Breast cancer screening. High-risk, bilateral prophylactic mastectomy, no reconstruction.
G. US Breast

Variant 5: Female. Breast cancer screening. High-risk, bilateral prophylactic mastectomy with autologous reconstructions.

Variant 5: Female. Breast cancer screening. High-risk, bilateral prophylactic mastectomy with autologous reconstructions.
A. Digital Breast Tomosynthesis Screening

Variant 5: Female. Breast cancer screening. High-risk, bilateral prophylactic mastectomy with autologous reconstructions.
B. Mammography Screening

Variant 5: Female. Breast cancer screening. High-risk, bilateral prophylactic mastectomy with autologous reconstructions.
C. FDG-PET Breast Dedicated

Variant 5: Female. Breast cancer screening. High-risk, bilateral prophylactic mastectomy with autologous reconstructions.
D. MRI Breast Without IV Contrast

Variant 5: Female. Breast cancer screening. High-risk, bilateral prophylactic mastectomy with autologous reconstructions.
E. MRI Breast Without and With IV Contrast

Variant 5: Female. Breast cancer screening. High-risk, bilateral prophylactic mastectomy with autologous reconstructions.
F. Sestamibi MBI

Variant 5: Female. Breast cancer screening. High-risk, bilateral prophylactic mastectomy with autologous reconstructions.
G. US Breast

Variant 6: Female. Breast cancer screening. High-risk, bilateral prophylactic mastectomy with nonautologous (implant) reconstructions.

Variant 6: Female. Breast cancer screening. High-risk, bilateral prophylactic mastectomy with nonautologous (implant) reconstructions.
A. Digital Breast Tomosynthesis Screening

Variant 6: Female. Breast cancer screening. High-risk, bilateral prophylactic mastectomy with nonautologous (implant) reconstructions.
B. Mammography Screening

Variant 6: Female. Breast cancer screening. High-risk, bilateral prophylactic mastectomy with nonautologous (implant) reconstructions.
C. FDG-PET Breast Dedicated

Variant 6: Female. Breast cancer screening. High-risk, bilateral prophylactic mastectomy with nonautologous (implant) reconstructions.
D. MRI Breast Without IV Contrast

Variant 6: Female. Breast cancer screening. High-risk, bilateral prophylactic mastectomy with nonautologous (implant) reconstructions.
E. MRI Breast Without and With IV Contrast

Variant 6: Female. Breast cancer screening. High-risk, bilateral prophylactic mastectomy with nonautologous (implant) reconstructions.
F. Sestamibi MBI

Variant 6: Female. Breast cancer screening. High-risk, bilateral prophylactic mastectomy with nonautologous (implant) reconstructions.
G. US Breast

Variant 7: Female. Palpable lump or clinically significant pain on the side of the mastectomy without reconstruction. Initial imaging.

Variant 7: Female. Palpable lump or clinically significant pain on the side of the mastectomy without reconstruction. Initial imaging.
A. Digital Breast Tomosynthesis Diagnostic

Variant 7: Female. Palpable lump or clinically significant pain on the side of the mastectomy without reconstruction. Initial imaging.
B. Mammography Diagnostic

Variant 7: Female. Palpable lump or clinically significant pain on the side of the mastectomy without reconstruction. Initial imaging.
C. FDG-PET Breast Dedicated

Variant 7: Female. Palpable lump or clinically significant pain on the side of the mastectomy without reconstruction. Initial imaging.
D. MRI Breast Without IV Contrast

Variant 7: Female. Palpable lump or clinically significant pain on the side of the mastectomy without reconstruction. Initial imaging.
E. MRI Breast Without and With IV Contrast

Variant 7: Female. Palpable lump or clinically significant pain on the side of the mastectomy without reconstruction. Initial imaging.
F. Sestamibi MBI

Variant 7: Female. Palpable lump or clinically significant pain on the side of the mastectomy without reconstruction. Initial imaging.
G. US Breast

Variant 8: Female. Palpable lump or clinically significant pain on the side of the mastectomy with reconstruction (autologous or nonautologous). Initial imaging.

Variant 8: Female. Palpable lump or clinically significant pain on the side of the mastectomy with reconstruction (autologous or nonautologous). Initial imaging.
A. Digital Breast Tomosynthesis Diagnostic

Variant 8: Female. Palpable lump or clinically significant pain on the side of the mastectomy with reconstruction (autologous or nonautologous). Initial imaging.
B. Mammography Diagnostic

Variant 8: Female. Palpable lump or clinically significant pain on the side of the mastectomy with reconstruction (autologous or nonautologous). Initial imaging.
C. FDG-PET Breast Dedicated

Variant 8: Female. Palpable lump or clinically significant pain on the side of the mastectomy with reconstruction (autologous or nonautologous). Initial imaging.
D. MRI Breast Without IV Contrast

Variant 8: Female. Palpable lump or clinically significant pain on the side of the mastectomy with reconstruction (autologous or nonautologous). Initial imaging.
E. MRI Breast Without and With IV Contrast

Variant 8: Female. Palpable lump or clinically significant pain on the side of the mastectomy with reconstruction (autologous or nonautologous). Initial imaging.
F. Sestamibi MBI

Variant 8: Female. Palpable lump or clinically significant pain on the side of the mastectomy with reconstruction (autologous or nonautologous). Initial imaging.
G. US Breast

Summary of Recommendations

Supporting Documents

The evidence table, literature search, and appendix for this topic are available at https://acsearch.acr.org/list. The appendix includes the strength of evidence assessment and the final rating round tabulations for each recommendation.

For additional information on the Appropriateness Criteria methodology and other supporting documents, please go to the ACR website at https://www.acr.org/Clinical-Resources/Clinical-Tools-and-Reference/Appropriateness-Criteria.

Appropriateness Category Names and Definitions

Appropriateness Category Name	Appropriateness Rating	Appropriateness Category Definition
Usually Appropriate	7, 8, or 9	The imaging procedure or treatment is indicated in the specified clinical scenarios at a favorable risk-benefit ratio for patients.
May Be Appropriate	4, 5, or 6	The imaging procedure or treatment may be indicated in the specified clinical scenarios as an alternative to imaging procedures or treatments with a more favorable risk-benefit ratio, or the risk-benefit ratio for patients is equivocal.
May Be Appropriate (Disagreement)	5	The individual ratings are too dispersed from the panel median. The different label provides transparency regarding the panel’s recommendation. “May be appropriate” is the rating category and a rating of 5 is assigned.
Usually Not Appropriate	1, 2, or 3	The imaging procedure or treatment is unlikely to be indicated in the specified clinical scenarios, or the risk-benefit ratio for patients is likely to be unfavorable.

Relative Radiation Level Information

References

1.	Green LA, Karow JA, Toman JE, Lostumbo A, Xie K. Review of breast augmentation and reconstruction for the radiologist with emphasis on MRI. [Review]. Clin Imaging. 47:101-117, 2018 Jan - Feb.
2.	Kummerow KL, Du L, Penson DF, Shyr Y, Hooks MA. Nationwide trends in mastectomy for early-stage breast cancer. JAMA Surgery. 150(1):9-16, 2015 Jan.
3.	Panchal H, Pilewskie ML, Sheckter CC, et al. National trends in contralateral prophylactic mastectomy in women with locally advanced breast cancer. Journal of Surgical Oncology. 119(1):79-87, 2019 Jan.
4.	Zakhireh J, Fowble B, Esserman LJ. Application of screening principles to the reconstructed breast. [Review] [94 refs]. J Clin Oncol. 28(1):173-80, 2010 Jan 01.
5.	Medina-Franco H, Vasconez LO, Fix RJ, et al. Factors associated with local recurrence after skin-sparing mastectomy and immediate breast reconstruction for invasive breast cancer. Ann Surg. 235(6):814-9, 2002 Jun.
6.	Kaoutzanis C, Xin M, Ballard TN, et al. Autologous Fat Grafting After Breast Reconstruction in Postmastectomy Patients: Complications, Biopsy Rates, and Locoregional Cancer Recurrence Rates. Ann Plast Surg. 76(3):270-5, 2016 Mar.
7.	Adrada BE, Whitman GJ, Crosby MA, Carkaci S, Dryden MJ, Dogan BE. Multimodality Imaging of the Reconstructed Breast. [Review]. Curr Probl Diagn Radiol. 44(6):487-95, 2015 Nov-Dec.
8.	Fajardo LL, Roberts CC, Hunt KR. Mammographic surveillance of breast cancer patients: should the mastectomy site be imaged?. AJR. American Journal of Roentgenology. 161(5):953-5, 1993 Nov.
9.	McCarthy CM, Pusic AL, Sclafani L, et al. Breast cancer recurrence following prosthetic, postmastectomy reconstruction: incidence, detection, and treatment. Plast Reconstr Surg. 121(2):381-8, 2008 Feb.
10.	Noroozian M, Carlson LW, Savage JL, et al. Use of Screening Mammography to Detect Occult Malignancy in Autologous Breast Reconstructions: A 15-year Experience. Radiology. 289(1):39-48, 2018 10.
11.	Patterson SG, Teller P, Iyengar R, et al. Locoregional recurrence after mastectomy with immediate transverse rectus abdominis myocutaneous (TRAM) flap reconstruction. Ann Surg Oncol. 19(8):2679-84, 2012 Aug.
12.	Romics L Jr, Chew BK, Weiler-Mithoff E, et al. Ten-year follow-up of skin-sparing mastectomy followed by immediate breast reconstruction. Br J Surg. 99(6):799-806, 2012 Jun.
13.	Warren Peled A, Foster RD, Stover AC, et al. Outcomes after total skin-sparing mastectomy and immediate reconstruction in 657 breasts. Ann Surg Oncol. 19(11):3402-9, 2012 Oct.
14.	Hedegard W, Niell B, Specht M, Winograd J, Rafferty E. Breast reconstruction with a deep inferior epigastric perforator flap: imaging appearances of the normal flap and common complications. AJR Am J Roentgenol. 200(1):W75-84, 2013 Jan.
15.	Mainiero MB, Moy L, Baron P, et al. ACR Appropriateness Criteria® Breast Cancer Screening. J Am Coll Radiol 2017;14:S383-S90.
16.	Rissanen TJ, Makarainen HP, Mattila SI, Lindholm EL, Heikkinen MI, Kiviniemi HO. Breast cancer recurrence after mastectomy: diagnosis with mammography and US. Radiology. 188(2):463-7, 1993 Aug.
17.	Monticciolo DL, Newell MS, Moy L, Niell B, Monsees B, Sickles EA. Breast Cancer Screening in Women at Higher-Than-Average Risk: Recommendations From the ACR. Journal of the American College of Radiology. 15(3 Pt A):408-414, 2018 03.
18.	Yilmaz MH, Esen G, Ayarcan Y, et al. The role of US and MR imaging in detecting local chest wall tumor recurrence after mastectomy. Diagn Interv Radiol. 13(1):13-8, 2007 Mar.
19.	Kim HJ, Kwak JY, Choi JW, et al. Impact of US surveillance on detection of clinically occult locoregional recurrence after mastectomy for breast cancer. Ann Surg Oncol. 17(10):2670-6, 2010 Oct.
20.	Lee JH, Kim EK, Oh JY, et al. US screening for detection of nonpalpable locoregional recurrence after mastectomy. Eur J Radiol. 82(3):485-9, 2013 Mar.
21.	Greenberg JS, Javitt MC, Katzen J, Michael S, Holland AE. Clinical performance metrics of 3D digital breast tomosynthesis compared with 2D digital mammography for breast cancer screening in community practice. AJR. American Journal of Roentgenology. 203(3):687-93, 2014 Sep.
22.	Friedewald SM, Rafferty EA, Rose SL, et al. Breast cancer screening using tomosynthesis in combination with digital mammography. JAMA. 311(24):2499-507, 2014 Jun 25.
23.	Caumo F, Bernardi D, Ciatto S, et al. Incremental effect from integrating 3D-mammography (tomosynthesis) with 2D-mammography: Increased breast cancer detection evident for screening centres in a population-based trial. BREAST. 23(1):76-80, 2014 Feb.
24.	Bernardi D, Ciatto S, Pellegrini M, et al. Application of breast tomosynthesis in screening: incremental effect on mammography acquisition and reading time. Br J Radiol. 2012;85(1020):e1174-1178.
25.	Bernardi D, Caumo F, Macaskill P, et al. Effect of integrating 3D-mammography (digital breast tomosynthesis) with 2D-mammography on radiologists' true-positive and false-positive detection in a population breast screening trial. European Journal of Cancer. 50(7):1232-8, 2014 May.
26.	Ciatto S, Houssami N, Bernardi D, et al. Integration of 3D digital mammography with tomosynthesis for population breast-cancer screening (STORM): a prospective comparison study. Lancet Oncol. 14(7):583-9, 2013 Jun.
27.	Helvie MA, Bailey JE, Roubidoux MA, et al. Mammographic screening of TRAM flap breast reconstructions for detection of nonpalpable recurrent cancer. Radiology. 224(1):211-6, 2002 Jul.
28.	Freyvogel M, Padia S, Larson K, et al. Screening mammography following autologous breast reconstruction: an unnecessary effort. Ann Surg Oncol. 21(10):3256-60, 2014 Oct.
29.	Lee JM, Georgian-Smith D, Gazelle GS, et al. Detecting nonpalpable recurrent breast cancer: the role of routine mammographic screening of transverse rectus abdominis myocutaneous flap reconstructions. Radiology. 248(2):398-405, 2008 Aug.
30.	Al-Khalili R, Wynn RT, Ha R. The Contact Zone: A Common Site of Tumor Recurrence in a Patient Who Underwent Skin-Sparing Mastectomy and Myocutaneous Flap Reconstruction. Curr Probl Diagn Radiol. 45(3):233-4, 2016 May-Jun.
31.	Rieber A, Schramm K, Helms G, et al. Breast-conserving surgery and autogenous tissue reconstruction in patients with breast cancer: efficacy of MRI of the breast in the detection of recurrent disease. European Radiology. 13(4):780-7, 2003 Apr.
32.	Lourenco AP, Moy L, Baron P, et al. ACR Appropriateness Criteria R Breast Implant Evaluation. Journal of the American College of Radiology. 15(5S):S13-S25, 2018 May.J. Am. Coll. Radiol.. 15(5S):S13-S25, 2018 May.
33.	Vanderwalde LH, Dang CM, Tabrizi R, Saouaf R, Phillips EH. Breast MRI after bilateral mastectomy: is it indicated?. Am Surg. 77(2):180-4, 2011 Feb.
34.	Golan O, Amitai Y, Barnea Y, Menes TS. Yield of surveillance magnetic resonance imaging after bilateral mastectomy and reconstruction: a retrospective cohort study. Breast Cancer Res Treat. 174(2):463-468, 2019 Apr.
35.	Grinstein O, Krug B, Hellmic M, et al. Residual glandular tissue (RGT) in BRCA1/2 germline mutation carriers with unilateral and bilateral prophylactic mastectomies. Surgical Oncology. 29:126-133, 2019 Jun.
36.	Gennaro G, Hendrick RE, Toledano A, et al. Combination of one-view digital breast tomosynthesis with one-view digital mammography versus standard two-view digital mammography: per lesion analysis. Eur Radiol. 2013;23(8):2087-2094.
37.	Waldherr C, Cerny P, Altermatt HJ, et al. Value of one-view breast tomosynthesis versus two-view mammography in diagnostic workup of women with clinical signs and symptoms and in women recalled from screening. AJR Am J Roentgenol 2013;200:226-31.
38.	Yang TL, Liang HL, Chou CP, Huang JS, Pan HB. The adjunctive digital breast tomosynthesis in diagnosis of breast cancer. Biomed Res Int. 2013;2013:597253.
39.	Dashevsky BZ, Hayward JH, Woodard GA, Joe BN, Lee AY. Utility and Outcomes of Imaging Evaluation for Palpable Lumps in the Postmastectomy Patient. AJR Am J Roentgenol. 213(2):464-472, 2019 08.
40.	Usmani S, Khan H, Ahmed N, Marafi F, Garvie N. Scintimammography in conjunction with ultrasonography for local breast cancer recurrence in post-mastectomy breast. British Journal of Radiology. 83(995):934-9, 2010 Nov.
41.	Gweon HM, Son EJ, Youk JH, Kim JA, Chung J. Value of the US BI-RADS final assessment following mastectomy: BI-RADS 4 and 5 lesions. Acta Radiol. 53(3):255-60, 2012 Apr 01.
42.	Edeiken BS, Fornage BD, Bedi DG, Sneige N, Parulekar SG, Pleasure J. Recurrence in autogenous myocutaneous flap reconstruction after mastectomy for primary breast cancer: US diagnosis. Radiology. 227(2):542-8, 2003 May.
43.	Devon RK, Rosen MA, Mies C, Orel SG. Breast reconstruction with a transverse rectus abdominis myocutaneous flap: spectrum of normal and abnormal MR imaging findings. [Review] [29 refs]. Radiographics. 24(5):1287-99, 2004 Sep-Oct.
44.	Shellock FG. Reference Manual for Magnetic Resonance Safety, Implants, and Devices: 2019 Edition. Los Angeles, CA: Biomedical Research Publishing Group; 2019.
45.	American College of Radiology. ACR Appropriateness Criteria® Radiation Dose Assessment Introduction. Available at: https://edge.sitecorecloud.io/americancoldf5f-acrorgf92a-productioncb02-3650/media/ACR/Files/Clinical/Appropriateness-Criteria/ACR-Appropriateness-Criteria-Radiation-Dose-Assessment-Introduction.pdf.

Disclaimer

The ACR Committee on Appropriateness Criteria and its expert panels have developed criteria for determining appropriate imaging examinations for diagnosis and treatment of specified medical condition(s). These criteria are intended to guide radiologists, radiation oncologists and referring physicians in making decisions regarding radiologic imaging and treatment. Generally, the complexity and severity of a patient’s clinical condition should dictate the selection of appropriate imaging procedures or treatments. Only those examinations generally used for evaluation of the patient’s condition are ranked. Other imaging studies necessary to evaluate other co-existent diseases or other medical consequences of this condition are not considered in this document. The availability of equipment or personnel may influence the selection of appropriate imaging procedures or treatments. Imaging techniques classified as investigational by the FDA have not been considered in developing these criteria; however, study of new equipment and applications should be encouraged. The ultimate decision regarding the appropriateness of any specific radiologic examination or treatment must be made by the referring physician and radiologist in light of all the circumstances presented in an individual examination