In a mammography method and apparatus to generate a tomosynthetic x-ray image of a breast of a patient, two tomosynthesis scans are successively implemented with different x-ray energies. In one of the scans, a synthetic projection image is generated from at least two projection images acquired in this scan, this synthetic projection image corresponding to a projection at a projection angle at which a projection image has been acquired in the other scan. A difference image, used to reconstruct the tomosynthesis x-ray image, is generated from this synthetic projection image and the projection image acquired in the other scan. Alternatively, in each scan a synthetic projection image is generated from at least two projection images acquired in that scan. Each synthetic projection image represents a projection at the same projection angle. A difference image, used to reconstruct the tomosynthesis x-ray image, is generated from these two synthetic projection images.