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Architectural distortion in 3D mammogram but not regular mammo

Implants removed 2017. In 2019 I had a normal mammo that showed dense breast tissue, which I’ve always had.   Dec 2020, I had the 3D mammo that showed the dense breast tissue and architectural distortion.  My doc wanted an ultrasound because of the dense tissue even though she has never asked for one before.  The ultrasound showed a hypoechoic mass. Called back for more imaging that showed the hypoechoic mass, deeper than wide with posterior shadowing. birads4. Had biopsy 1/8/20. She said it’s probably scar tissue. Hopefully that’s the case but is it odd that my mammo from 2019 didn’t show any distortion and this one did? I also had four biopsies when I had implants that all came back benign but never had the shadowing or deeper than wide details on the report.
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Avatar universal
Architectural distortion is a mammographic finding associated with a high positive predictive value for malignancy. It is detected more frequently on 3D mammography (tomosynthesis) than on 2D mammography and may even be occult on conventional 2D imaging.

Source: https://pubs.rsna.org/doi/full/10.1148/rg.2016150093
973741 tn?1342342773
Hi there.  So, what is your next step?  Are you having a biopsy?  I want to tell you that I had a birads of 5 on my very first mammogram.  Scared the poop out of me.  I went straight from mammo to breast surgeon.  They did a needle biopsy.  My issue was calcifications that were abnormal from number, spacing, surface, shape, etc.  I hit all the ways they could be suspicious.  I did NOT Have cancer.  My results were clear.  I haven't had an abnormal mammogram now in 12 years.  I, like you, get 3 D mammograms now and have dense tissue.  I'm sure this is worrisome but the fact that it is likely scar tissue makes perfect sense.  Why it shows on one mammo vs another is that it may be newly developed.  Scar tissue can build and may start out soft after implant surgery but grow harder.  Tell us what happened on your follow up. hugs
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