In mammography, skin tears happen. Some are avoidable, while others are not. If a patient pulls away from the receptor plate too fast after the compression paddle has been released, the breast can stick to the plate and a tear can occur before the technologist can say, “don’t back up.”
Many times, the patient and the technologist do not even know the tear has occurred until they have left the imaging center. Many times the patient discovers it the next day while showering, the soap hits the area (ouch), and the streak of pain begins.
So, that “15 minute” mammogram where the technologist said, “Let’s get you started so we can get you out of here and you can go about your day” has just been extended from 15 minutes to days or even weeks for someone with a skin tear.
This is because those skin tears are painful - very painful.
If you have never experienced one, think of your last paper cut and how it may have made you wince from the pain days afterward. Can you imagine having one under the breast?
A bad experience; a perception of uncaring
If a patient calls the imaging center to report the tear she may be told that “this is common” and told not to worry. While the breast imaging staff may feel that they are putting that patient’s concerns at ease by indicating it is not life threatening and it is nothing to be alarmed about, the patient hears “you don’t care about me”.
In most cases, patients do not know how to care for this type of wound due to its location and lack of air to heal.
It is hard to wear a bra and “go about one’s day” when you have a cut under your breast.
So not getting help from their imaging center, they do what everyone does – talk to family, friends, and strangers on social sites about their experience at that breast center. (In case anyone with a current skin tear is reading this and looking on how to care for your wound, I found some guidelines from the Ontario Breast Screening Program).
Negative word of mouth and mouse
Skin tears, in my mind, are one of the top ways in which negative word-of-mouth occurs.
Let’s look at a possible scenario:
A patient calls her friend and says “I had a mammogram at (fill in the blank) imaging center and they tore my breast, it is so painful! And then, I called to let them know and they said… get this… that is common! I’m not going back there, they didn’t even care! Has this ever happened to you? Where do you go? Maybe I should try your center.”
Then she turns on her computer to post on message boards or community forums about their experience, looking for sympathy and help on how to care for this type of wound. The community starts to chime in -- sharing their own experiences, offering advice, telling them to go to ACR (now that person did their research!), contact a lawyer, start a class action lawsuit, or even worse, recommending to stop going for a mammogram! One guest on the message board even invented a name for it… TMI (Traumatic Mammogram Injury).
It is scary to believe the amount of posts from women indicating they will no longer go for a mammogram over a skin tear and / or how the technologist hurt them in the process of having their exam.
Not only does a bad experience affect the breast center where it happened; on a broader level, it also impacts overall screening mammography if women are not returning for a mammogram.
“Feels like I was sliced with a knife…”
Below is a post from a message board on a patient’s experience with a skin tear:
“I just had a mammogram today to rule out a lump... The tech did some shots, then switched to some small paddles... SHE hurt me SO badly and I told her that it really hurt...she said yeah that the smaller paddles smash the breast thinner and that they hurt more. Needless to say I about died by the time she was done and I was in a lot of pain."
“Upon getting dressed I realized that my skin had been torn underneath my breast and was just about to start bleeding. I went out and talked with them and they said Yeah it happens sometimes.... They didn't really care!!!!"
“WOW. So, now I am left with a 4 inch long injury that may take up to a month to heal and they think I should just be ok with this!????"
“I went to work and my bra was rubbing on it... I had to leave work, get some Neosporin and bandages, go home and dress the injury."
“Has anyone else had this happen to them??? I have had many mammograms and now I’m left to wonder if I will ever have another one! Wasn't worth being in this kind of pain, feels like I was sliced with a knife under my breast. Do they really need to rip a woman's breast off of her body to tell her if she has cancer or not?”
And this is just a small sampling of this type of post. Treato.com is a website that shares what patients are saying about their treatment. When I put “mammography” in the search field, over 93,000 discussions came up in the search. People are sharing their experience.
Steps breast imaging centers can take to reduce skin tears:
So what are some impactful steps Breast Imaging Centers can take regarding skin tears?
- Before the mammogram begins, share with the patient that once you release the compression paddle, their instinct will be to quickly “back away” from the receptor plate but they should not.
- If a skin tear does occur, acknowledge it with compassion. Explain to the patient why it can occur i.e. thin skin, sensitive skin, certain medications can make skin more fragile, dry skin, etc.
- Create an informational sheet or “care plan” on how to attend to the skin tear for the patient to take home.
- Document the tear in the patient’s file so that the technologist will be aware for future visits.
- Create a script for the staff on how to respond to a patient that calls in with a skin tear. Take time to listen and acknowledge their concern. Then email / mail the care plan after you explain it over the phone. Start with an apology “I’m sorry Mrs. Jones that you have experienced this. Skin tears can occur for various reasons. I can work with you on a care plan for your tear, how does this sound?” After you have discussed the care plan, ask “Do you have any other concerns I have not addressed today?” Make sure you tell the patient that you will add this information to her chart so that when she returns, the technologist will be aware she is susceptible to tearing.
- Follow up with a compassion note from the technologist or radiologist or a follow up email to ask how she is feeling. Showing that you care can turn the negative experience with a tear into a positive experience with your breast imaging facility. Your patient will most likely return for her screening mammograms, and at your imaging center.
- To avoid skin tears, try using a Bella Blankets protective coverlet to help prevent the breast from sticking to the plate.
Striving towards a better patient experience
Dr. Kathleen Reardon wrote about her own experience in a blog for the Huffington Post.
Her post, “The Mammogram Assault! It Doesn’t Have to Happen to You!” sums it up best on how a little compassion can go a long way. She writes, “In my experience, if you need an MRI the radiologists act as if they can’t do enough for you: music of your choice, some gentle words, a tap on the knee, and a call button to use at any time, for any reason. Yet here’s a test (mammograms) that is also scary at best, quite painful for many women, and the message this tearful woman got was the equivalent of “Next! Come on! Woman up!”
So yes, skin tears happen in mammography. But maybe they don’t have to happen quite so often. If you’re interested in reducing skin tears in your susceptible patients, why not give Bella Blankets protective coverlets a try?
Contact your Beekley Medical Account Manager at 1-800-233-5539 or firstname.lastname@example.org to ask about a trial evaluation for your imaging center.