What to Expect During a Mammogram: A Step-by-Step Guide

For many women, the first mammogram comes with a fair amount of uncertainty. Knowing what will happen at each stage of the appointment can reduce anxiety and help you prepare. This guide walks through the entire process, from scheduling to receiving your results.

Before the Appointment

Scheduling

If possible, schedule your mammogram for one to two weeks after the start of your menstrual period. Breasts tend to be less tender during this window, which can make the compression more comfortable. If you are postmenopausal, any time is fine.

When you call to schedule, mention if you have breast implants, as the facility will need to allocate extra time. If you have had mammograms at a different facility in the past, request that those images be sent to your current facility before your appointment. Having prior images available for comparison helps the radiologist identify changes.

Day-of Preparation

On the day of your mammogram, do not apply deodorant, antiperspirant, lotion, cream, or powder to your underarms or chest area. These products can contain particles that show up as white spots on the mammogram image and may be mistaken for calcifications. If you accidentally apply deodorant, wipe it off thoroughly before the exam. Some facilities provide wipes for this purpose.

Wear a two-piece outfit so you only need to undress from the waist up. You will be given a gown to wear during the exam. Leave necklaces at home or be prepared to remove them.

If you find mammograms uncomfortable, consider taking an over-the-counter pain reliever such as ibuprofen or acetaminophen 30 to 60 minutes before your appointment. Discuss this with your doctor first if you have any medical conditions that might be affected.

At the Facility

When you arrive, you will check in and complete paperwork about your medical history and any breast-related symptoms. The form will ask about prior breast surgeries, hormone use, family history of breast cancer, and the date of your last menstrual period. Answer as accurately as you can, as this information helps the radiologist interpret your images.

You will be shown to a changing area where you can remove your top and bra and put on a gown. You will keep your bottoms on. Most facilities have lockers for your belongings.

During the Exam

A mammography technologist, also called a radiologic technologist, will guide you through the exam. They will position one breast at a time on a flat platform attached to the mammography machine. A clear plastic paddle will then lower onto the breast to compress it.

The compression serves two important purposes. First, it spreads the breast tissue so that overlapping structures do not obscure potential abnormalities. Second, it holds the breast still to prevent motion blur and allows a lower radiation dose to produce a clear image.

For each breast, two views are typically taken: one from above (craniocaudal, or CC view) and one from the side (mediolateral oblique, or MLO view). The technologist will adjust your body position for each view, which may involve lifting your arm, turning your shoulders, and tilting slightly.

Each compression lasts about 10 to 15 seconds. Most women describe the sensation as firm pressure. Some find it uncomfortable, and a smaller number find it briefly painful. The discomfort ends as soon as the paddle is released.

The actual imaging takes about 10 to 15 minutes for a standard four-image screening mammogram. A 3D mammogram (tomosynthesis) may take slightly longer, as the machine makes a brief sweep during each compression. The entire appointment, including check-in and changing, typically takes 20 to 30 minutes.

After the Exam

Getting Your Results

Under the Mammography Quality Standards Act (MQSA), facilities are required to send you a results letter written in plain language. Many facilities now also provide results through online patient portals, sometimes within 24 to 48 hours.

Your results will fall into one of several BI-RADS categories:

• BI-RADS 0: Incomplete. Additional imaging is needed. This is common, especially for first-time mammograms.
• BI-RADS 1: Negative. No abnormalities found.
• BI-RADS 2: Benign finding. Something was seen, but it is clearly not cancer (such as a cyst or calcification).
• BI-RADS 3: Probably benign. A short-interval follow-up (usually six months) is recommended.
• BI-RADS 4: Suspicious. A biopsy is recommended.
• BI-RADS 5: Highly suggestive of malignancy. A biopsy is strongly recommended.

If You Are Called Back

Receiving a callback does not mean you have cancer. About 10 to 12 percent of women are asked to return for additional views after a screening mammogram. Of those called back, the vast majority, roughly 90 to 95 percent, are found to have benign findings or normal tissue that simply needed a closer look.

Additional imaging may include spot compression views (magnified images of a specific area), ultrasound, or, less commonly, breast MRI. If a suspicious finding persists after additional imaging, a biopsy may be recommended.

Tips for a Better Experience

• Communicate with your technologist. If the compression is too painful, say so. Minor adjustments may help.
• Bring your insurance card and a list of any breast-related symptoms or concerns.
• Ask about breast density. Under the 2024 FDA rule, your results letter will include information about your breast density category.
• Keep records. Note where and when you had each mammogram so you can request prior images if you change facilities.