Breast Biopsy

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Overview

A mammogram can show an abnormal change in breast tissue, but only a biopsy can determine whether or not it is malignant. A biopsy involves removing all or part of the abnormal tissue and sending it to a laboratory for examination.

In the not so distant past, biopsy and mastectomy were done as a one-step procedure. The biopsy was performed while the patient was under general anesthesia, and the tissue was immediately sent to the laboratory for analysis. The patient was kept anesthetized until the surgeon received the results. If the lump was malignant, a mastectomy was performed. The one-step procedure is rarely done today, unless the patient is too frail or ill to undergo repeated anesthesia and surgery. Patients have time to discuss treatment options, get a second opinion, and make a decision.

Types of Breast Biopsy

There are several types of breast biopsy: open excisional biopsy, axillary node dissection, sentinel node dissection, and needle aspiration. The selection of technique depends on the size, location, and characteristics of the lump and whether or not the lump is palpable (i.e., can be felt externally).

Open Excisional Biopsy

This procedure can be performed whether or not the breast mass is palpable and is usually performed under local anesthesia (i.e., the patient remains awake during the procedure). The area is numbed with a local anesthetic and a sedative is usually administered. A small incision of about 1 to 2 inches is made as close to the lump as possible. The surgeon removes a piece of tissue, or if it is small, the entire lump and the incision is sutured. The biopsy usually takes about an hour to perform.

If the lump cannot be felt, the procedure is slightly more involved and time consuming. Because it cannot be felt, it must be located by a process called needle localization. The patient goes to radiology and a mammogram is used to pinpoint the lump. A wire needle is inserted into the breast, marking the location of the lump. The wire is left inside the breast and taped to the skin, and the patient is taken to the operating room to have the biopsy.

Preoperative Procedures

This type of biopsy is usually done on an outpatient basis. Many biopsies are performed at surgical centers. If it is done at the hospital, the patient usually goes to an area for outpatients prior to surgery.

If the patient is taking medication that "thins" the blood, including aspirin, they should speak to the physician about it as soon as the decision to do the biopsy has been made. It is common for blood thinners to be discontinued several days prior to a scheduled operation to avoid abnormal bleeding during the procedure.

The patient must sign an informed consent form acknowledging that the procedure and potential risks have been explained.

Some patients receive a sedative prior to the procedure through an intravenous (IV) or by injection.

Postoperative Care

Following the procedure, the patient goes to the recovery room and is monitored by the nursing staff. Recovery from a biopsy done under local anesthesia is generally rapid.

Postoperative pain is usually minimal and resolves within a few days. However, pain medication may be prescribed. The patient may return to work the day after biopsy, if their job is not physically demanding. For 1 to 2 weeks following the procedure, heavy lifting should be avoided. The incision should completely heal within 1 month, and the stitches dissolve or are removed a week to 10 days later at the doctor's office.

The effects of sedation can wear off very quickly or may take several hours. The patient must be accompanied home after the biopsy and may still be very groggy.

Strenuous activity should be avoided for the first 2 or 3 weeks following the biopsy to prevent bleeding. Stitches should be kept dry to prevent infection, and sponge baths may be recommended until they are removed.

Many patients are anxious about the cosmetic appearance of their breast following biopsy. The incision leaves a small scar that fades in time. The location of the lesion, its size, and the amount of surrounding tissue removed determines whether or not the breast changes in appearance. For example, if a very large lump was removed, the scar may be large and may leave an indentation in the breast.

Postoperative Complications

Few complications are associated with biopsy. Infection can occur, and the incision site should be watched for redness, swelling, or fluid leakage that should be reported to the physician immediately.

All surgery causes internal scarring. Scar tissue can interfere with readings of future mammograms.

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