Contrast Enhanced Spectral Mammography (CESM) and Contrast Enhanced Digital Breast Tomosynthesis (CEDBT) are multi-energy X-ray imaging techniques involving the injection of a vascular contrast agent. Both techniques provide information on hypervascularization of lesions through contrast uptake. CESM has proved to deliver a better diagnosis of breast cancer than diagnostic mammography. CEDBT is a promising technique which provides 3D information on the contrast uptake distribution. In this paper, new steps in the image acquisition process of a previously presented image acquisition simulation platform are described, including models of scatter, image lag and electronic noise. Using this simulation platform, 290 CESM and CEDBT images were generated. A human observer experiment was then performed to compare lesion detectability and characterization. The results indicate a similar detectability and an improved characterization of shape and contrast enhancement distribution using CEDBT.