Breast Imaging

Breast imaging is used to help identify and diagnose any changes or abnormalities in the breast.

We offer the following types of breast imaging;

Mammograms (including contrast-enhanced mammography)
Breast ultrasound
Interventional procedures (ductogram/galactogram, breast biopsy, including ultrasound core biopsy, stereotactic core biopsy and fine needle aspiration biopsy and contrast-enhanced digital mammography biopsies)
Tomosynthesis (a type of mammogram that produces 3D images of the inside of your breasts)

The Marvelle Koffler Breast Centre at Mount Sinai Hospital was the first in North America to use digital mammography.

Our radiologists work at all locations of the Joint Department of Medical Imaging and you will receive the same quality of care at any of our breast imaging sites. Mammography is accredited by the Canadian Association of Radiologists.

Ontario Breast Screening Program (OBSP)

We are an Ontario Breast Screening Program assessment site, as part of our partnership with Cancer Care Ontario. The OBSP is a province-wide cancer screening program that provides mammograms to Ontario women between 50 and 75 years old, with no previous history of breast cancer, no implants and no current breast symptoms.

You do not need a referral from a doctor for the OBSP. Please contact the Marvelle Koffler Breast Centre directly to make an appointment. Our staff will ask you several questions to confirm your eligibility. To be eligible for the program you must:

Be between 50 and 75 years of age
Not have had a mammogram in the last 11 months
Have no current breast implants
Have no previous breast cancer
Have no current breast symptoms, for example, the recent discovery of a lump, bleeding or new discharge from the nipple area or a reddened breast

Learn more about screening mammograms.

OBSP High Risk Screening Program

Women ages 30 to 69 can get screened through the High Risk OBSP if they have a referral from their doctor, a valid Ontario Health Insurance Plan number, no acute breast symptoms, and fall into one of the following risk categories:

Known to have a gene mutation that increases your risk for breast cancer (e.g. BRCA1, BRCA2, TP53, PTEN, CDH1)
A first-degree relative of someone who has a gene mutation that increases their risk for breast cancer (e.g. BRCA1, BRCA2, TP53, PTEN, CDH1), have already had genetic counselling and have chosen not to have genetic testing
Have been assessed at a genetics clinic (using the IBIS or BOADICEA tools) as having a 25 per cent or greater lifetime risk of breast cancer based on personal and family history
You have had radiation therapy to the chest to treat another cancer or condition (e.g. Hodgkin Lymphoma) before age 30 and at least eight years ago

Speak with your physician to be referred to this program. They will need to submit an OBSP high risk program referral form.

Your appointment

How to prepare for your test

Please arrive 15 minutes before your appointment. If you are late, your appointment may be rescheduled.
Bring your health card.
Avoid wearing perfumes or using heavily-scented care products. We are a scent-sensitive environment.
Wear two-piece clothing as you will be asked to undress from the waist up.
Do not wear jewelry and do not apply any powder, lotions or deodorants on the day of the test, as they can impact results.
Bring (or send in advance) any previous mammogram exams done at another facility.
If you wish to have another doctor copied on the results report, please let the receptionist know before your test.

What to expect at your appointment

The length of your appointment will depend on what kind of imaging test you are having. Mammograms and ultrasounds can take about one hour or longer depending on the complexity of the exam. Ductograms, biopsies and pre-operative needle localizations vary from 45 minutes to 60 minutes. You may need to stay 15 minutes after a biopsy for observation.
We do our best to stay on time. Unfortunately, your appointment may be delayed by unforeseen circumstances. We recommend you come prepared for delays.
We will give you a hospital gown to put on for the procedure.

After your breast imaging appointment

We will provide you with instructions for how to care for yourself after a biopsy.

A report will be sent to your doctor(s) within 10 days. However, biopsy results can take a bit longer to process. Your referring doctor will discuss the results with you.

Types of breast imaging procedures

Mammogram

A mammogram is a digital x-ray of breast tissue. It can give doctors information about lumps, calcifications and other abnormalities that may be present in the breast. Mammograms are also used to screen women for breast cancer.

During your mammogram you stand in front of the x-ray machine with your breasts resting on a plate. Your breast will be gently but firmly compressed during the exam. This can be uncomfortable but it doesn’t last long. The breast needs to be compressed to separate breast tissue and keep the radiation dose to a minimum.

You may wish to schedule your mammogram two weeks after your period has ended.

Before the start of the procedure, please inform the technologist of the following:

Any chance of pregnancy
Any implanted devices such as a pacemaker or port
Any shoulder or other mobility restrictions
Any skin conditions

Breast ultrasound

A breast ultrasound uses sound waves to create a picture of the breast. It can show areas of the breast, like the areas closest to the chest, which are difficult to see in a mammogram. A breast ultrasound can also give your physician more information about lesions or masses that were identified on a mammogram or felt by you or your physician.

During your ultrasound you will lie on your back with your arm raised above your head on the examination table. The technologist will apply a water-based gel to the breast and then press the ultrasound probe firmly against the skin and glide it over the area of interest several times.

Ductogram/galactogram

This procedure is used when a person has breast discharge, in order to determine where (which duct) the discharge is coming from.

Before the procedure, we may apply a warm towel to your breast. The towel will stimulate the duct to discharge the fluid.

If the radiologist is able to see the duct expressing the discharge, a thin, flexible tube (called a blunt-tipped cannula) is inserted into the discharging duct. Then, a small amount of contrast dye is injected into the duct through the cannula.

Some people experience a sensation of fullness or pressure when the dye is injected.

After the dye has been injected, the technologist will take some mammogram pictures of the ducts.

You can return to your normal activities as soon as the procedure is over.

Breast biopsy

Important precautions:

If you are taking anti-coagulants (blood thinner medication), please talk to your doctor about this before your appointment. Depending on the specific medication, a recent INR may be needed and should be provided by the referring physician in advance of your scheduled appointment.

Your doctor should contact us if there is any concerns or known allergies to local anesthetic before your biopsy.

We strongly suggest you have a friend or family member accompany you home after the biopsy and post procedure care sheet will be given to you to provide information on biopsy care.

A breast biopsy is a procedure to remove a small amount of breast tissue for testing. It is done when a mammogram identifies something that your physician wants to investigate further.

We complete breast biopsies in a few different ways:

Stereotactic core biopsy

A stereotactic core biopsy is used to obtain breast tissue when small calcium deposits are seen on a mammogram.

During the procedure, you will either sit or lie on your side with your breast compressed between two flat plates. We will make you as comfortable as possible since it is very important that you do not move during the entire procedure.

The radiologist will freeze the area to be biopsied with a local anesthetic. Several tissue samples will be taken and then x-rayed to see if they contain calcifications. A mammogram will be performed during the procedure as well.

The radiologist may place a clip in the biopsy site at the end of the procedure for future reference if deemed necessary.

Ultrasound-guided core biopsy

In an ultrasound-guided core biopsy, the doctor inserts a needle in an area in the breast through a small cut in the skin to obtain tissue samples.

Local anesthetic (freezing) will be given to numb the area. The doctor may take several samples.

Core biopsy is performed using a device that makes a loud clicking noise or a vacuum assisted device.

You may feel some discomfort or pressure during the biopsy.

The radiologist may place a clip in the biopsy site at the end of the procedure for future reference if deemed necessary

Fine Needle Aspiration Biopsy

A fine needle aspiration biopsy uses ultrasound and a thin needle to collect a sample of fluid or cells from the breast or lymph node. The sample is analyzed under a microscope to give a more accurate diagnosis.

You will be asked to lie on your back on the examination table, as you would for a regular breast ultrasound. The radiologist will locate the area of interest and will freeze the area with a local anesthetic. Once the area is frozen, the radiologist will use a fine needle to take cell samples.

Digital Breast Tomosynthesis (DBT)

Digital breast tomosynthesis (DBT), is an advanced form of breast imaging, or mammography, that takes multiple images of your breast to construct a 3D image.

DBT can be useful in many cases, but it’s especially helpful when the patient has dense breast tissue, which can make it difficult to identify cancer on a standard two-dimensional mammogram.