Breast Biopsy

What is a Breast Biopsy?

A biopsy is the removal of a small amount of tissue and its analysis in a laboratory. A special biopsy needle can be used to remove breast tissue. It may also be removed during surgery. It is examined to determine if there are any cancerous or abnormal cells.

What are the reasons I might need a breast exam?

 

It is possible to do breast biopsies:

  • To feel (is palpable in the breast) a lump or other mass
  • To check a problem seen on a mammogram, such as small calcium deposits in breast tissue (microcalcifications) or a fluid-filled mass (cyst)
  • To assess nipple issues, such as bloody discharge from nipple
  • Find out if a breast mass or lump is cancerous (malignant) or benign (benign).

Cancer may cause a lump or other concern in the breast. It could also be caused by a less serious condition.

Your doctor may recommend a breast exam for other reasons.

Different types of breast biopsies

There are many types of breast biopsy procedures. The location of the breast lump and the size of the concern will determine the type of biopsy you choose.

You can have biopsies done either under general or local anesthesia. Local anesthesia is when medicine is injected to numb the breasts. The injection will make you feel awake but not in pain. You will be put to sleep with general anesthesia during the biopsy.

There are several types of breast biopsies:

  • Fine needle aspiration (FNA), biopsy. A thin needle is inserted into the area or lump of concern. The needle is used to remove a small amount of tissue or fluid. There is no need to make an incision. To determine if there is a cyst or a lump, an FNA biopsy can be performed.
  • Core needle biopsy. The large needle is inserted into the area or lump. Cores are small cylinders made of tissue that are then removed. There is no need to make a cut.
  • Open (or surgical) biopsy. A cut is made to the breast. The surgeon will remove part of the lump or concern. Sometimes the lump can be very small or deep and difficult to locate. A method known as wire localization can also be used. A thin needle with a very fine wire is inserted into the breast. The X-ray images can help the surgeon locate the lump. This wire is then followed by the surgeon to locate the lump.

To guide needles and assist with biopsy procedures, special tools and methods might be required. These tools and methods include:

  • Stereotactic biopsy. This method uses a combination of mammogram results and a computer to create a 3D image. The 3D image guides the biopsy needle to exactly the location of the breast lump.
  • Core biopsy using vacuum-assisted vacuum. A small cut is made to the breast. Through the cut is inserted a hollow tube or probe. The probe is guided by MRI, Xrays or ultrasound to the breast mass. The probe is gently pulled through the breast tissue. The tube contains a spinning knife that cuts through the tissue. Multiple tissue samples can be taken simultaneously.
  • Ultrasound-guided biopsy. This technique uses ultrasound images to locate the breast lump. These images are used to guide the needle to the exact site of the biopsy.

What are the risks associated with a breast-feeding biopsy?

There is always risk involved in any procedure. A breast biopsy can lead to the following complications:

  • Mild pain and swelling at the site of the biopsy
  • Bleeding from the biopsy site for a prolonged period
  • Infection at the biopsy site

The radiation dose required for a biopsy using an Xray is very low. Radiation exposure is extremely rare.

There may be other risks that you face depending on your medical condition. Before the biopsy is performed, be sure to talk with your healthcare provider about any concerns.

How can I prepare for a breast exam?

The procedure will be explained to you by your provider. Ask your provider any questions about the procedure.

  • A consent form will be required to give your consent to the procedure. If you are unsure, take the time to read and ask questions.
  • If your breasts are numbed (localanesthesia), but you’re still awake, there is no need to prepare for the biopsy. If you have been given medication to induce deep sleep (general or local anesthesia), it is important that you do not eat or drink fast for a while before you go under general anesthesia. You will be given specific instructions by your surgeon.
  • On the day of your procedure, don’t apply lotion, creams, powders, deodorant or perfume to your breasts, arm or underarm.
  • If you think or are pregnant, tell your provider.
  • If you have any allergies or sensitivities to medicines, latex, tape, or anesthesia medications (local and general), tell your provider.
  • Inform your doctor about all medications you use. This covers both prescription and over-the-counter medicines. This includes vitamins, herbs, as well as other supplements.
  • If you have had bleeding problems in the past, tell your provider. Tell your provider if you take blood-thinning medications, such as aspirin, ibuprofen or any other medication that can affect blood clotting. These medicines may need to be stopped before you have your biopsy.
  • After you receive a general or sedative, you should have someone drive you home. After the biopsy, you will not be allowed to drive.
  • Based on your medical condition, your healthcare provider might have additional instructions for you.

What happens during a breast exam?

A provider may perform a breast biopsy in your office. You may go home that day if it is done outpatient. It may also be performed in a hospital. Local anesthesia is not required for certain types of biopsies. General anesthesia is required for all other types. The procedure may differ depending on the condition of your provider and the type of anesthesia you choose.

A needle breast biopsy is usually performed after this procedure.

  1. Then, you will be asked to take off all clothing that is not at the waist.
  2. You can either lie down or stand. It all depends on the preference of your provider and whether X-rays or ultrasound guidance are used.
  3. A sterile solution will be used to clean the skin around the biopsy site.
  4. You will feel the needle stick as the local anesthetic is administered. There may be a slight stinging sensation. The biopsy will not begin until the area is completely numb.
  5. The probe will be placed on the breast of the patient to detect any breast lumps or masses.
  6. Stereotactic imaging uses the technique of placing your breasts in an opening on a table. Computers will locate the exact location of breast lumps or other concerns.
  7. During the procedure, you will need to remain still. You won’t have to keep your breath.
  8. The provider will insert the needle directly into the biopsy site, or make a small cut (incision). The provider will take a small amount of tissue or fluid. The doctor may put pressure on your skin to collect the sample.
  9. Until the bleeding stops, pressure will be applied at the site of the biopsy.
  10. The opening can be closed using adhesive strips or stitches if necessary.
  11. An application of a sterile dressing or bandage will be made.
  12. The lab will examine the tissues.

This procedure will usually be followed by an open breast biopsy.

  1. Then, you will need to take off your clothes and be given a gown.
  2. You may have an IV (intravenous), line placed in your arm or hand.
  3. The operating table will place you.
  4. To relax, you may be prescribed medication (a sedative).
  5. Local anesthesia will cause you to feel a needle sticking to your breast tissue.
  6. General anesthesia will be administered. During the procedure, the anesthesiologist will continue to monitor your heart rate, blood pressure and breathing.
  7. Sometimes, an X-ray image will guide the doctor to insert a wire into the lump. This is done to assist the doctor in locating the breast lump. You may also use other X-ray-guided techniques.
  8. A sterile solution will be used to clean the skin around the surgery site.
  9. Once the lump or mass has been exposed, a small cut will take place in your skin and the underlying breast tissue.
  10. You can have a portion or all of the lump removed.
  11. The opening will then be sealed with adhesive strips or stitches.
  12. An application of a sterile dressing will be made.
  13. The lab will examine the tissue.

What happens following a breast exam?

The type of surgery and anesthesia used will determine how long it takes for you to heal.

If you received general anesthesia, you’ll be taken to the recovery area, where you will continue to be closely monitored. You will be released from the hospital once your pulse, blood pressure, and breathing are stabilized and you feel alert. You can go home. You should arrange for another person to drive you home if the biopsy was performed on an outpatient basis.

Local anesthesia will allow you to return home once you are fully recovered.

At home

Make sure the area around the biopsy is dry and clean. If stitches were used, these will be removed at a follow up office visit. If no stitches are present, the bandage/dress can be removed if instructed.

After surgery, the biopsy site can be tender for several days. Your doctor may recommend that you take a pain medication. Your risk of bleeding may be increased by taking aspirin and certain pain medications. Make sure you only take the recommended medications. A supportive bra can help mild pain.

Unless your doctor tells you otherwise, you can return to your usual diet. For a few days, you may be advised to stop doing strenuous exercise.

If you experience any of these symptoms, please contact your healthcare provider.

  • Chills or fever
  • The biopsy site may experience redness, swelling, bleeding or any other type of drainage.
  • Pain around the biopsy site is increased

Depending on your specific situation, your healthcare provider might give you additional instructions.

Next steps

Be sure to learn the following information before you consent to any test or procedure.

  • The procedure or test name
  • Why are you having the procedure or test?
  • What to expect from the results and what they mean
  • The benefits and risks of the procedure or test
  • What are the possible side effects and complications
  • What time and where are you going to have the procedure or test?
  • What are the qualifications of the person who will perform the test/procedure?
  • What would you do if the procedure or test was not available?
  • Are there any other tests or procedures you might be interested in?
  • How and when will you achieve the results?
  • If you have any questions, or need assistance after the procedure or test, who do you call?
  • What amount you’ll have to pay for the procedure or test

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