During a breast biopsy, your surgeon or a radiologist removes a small tissue sample (biopsy) from your breast. Typically, a biopsy is performed if your provider is concerned about abnormal findings on your mammogram or ultrasound, or there is a lump felt in your breast. Abnormal cells may be present and a biopsy can confirm if they are cancerous. Once the tissue is removed, the biopsy is sent to a laboratory for close analysis. A pathologist examines the tissue sample under a microscope to check for the presence of cancerous cells.
Roughly 20% of biopsies will be positive for a cancer diagnosis. That means that 80% of biopsies will be negative for cancer cells.
If your provider recommends a biopsy, try to stay calm and ask whatever questions you may have about why you need a biopsy, and what the outcomes may mean for you.
A breast biopsy is performed to determine if there is cancer in the breast. Your surgeon may recommend you have a biopsy:
- If you had a suspicious finding on a mammogram or other diagnostic imaging tests, such as an ultrasound or MRI
- To check on a lump that is large enough you can feel it in the breast
- To confirm what is causing nipple problems, such as bloody discharge or skin changes
The type of biopsy your provider recommends will be based on your individual situation, including the size and location of the area of concern, if it can be felt in a physical examination, if the area looks concerning, as well as your overall health status and personal preferences.
In some instances, a breast biopsy is performed under local anesthesia in an office setting. In others, it may need to be performed in a hospital operating room under general anesthesia. Additionally, biopsies may be combined with imaging such as an ultrasound (ultrasound-guided biopsy), an MRI (MRI-guided biopsy) or a mammogram (stereotactic biopsy).
The three primary types of breast biopsies include:
- Fine-needle aspiration (FNA) biopsy. This type of biopsy is typically performed if your provider found a lump in your breast during a physical examination and believes it to be filled with fluid instead of being a solid mass. As you lie on a table, your provider will use a local anesthetic, such as lidocaine, to numb the area. Then, he or she inserts a thin needle into the lump and collects a sample of cells and/or fluid. In some instances, your provider may also use an ultrasound to help them locate the correct biopsy location. Typically, if the lump was full of fluid, it should collapse once the fluid has been removed.
- Core needle biopsy. Your provider may recommend this type of biopsy if there is a mass visible on a mammogram or ultrasound, or if a lump was found during a physical examination and your provider believes it is a solid mass. Typically performed in an office setting, your provider will locally numb the area and insert a hollow needle into the mass to remove a tissue sample. Often, an ultrasound or MRI-imaging will be used to better locate the area needing to be sampled.
- Surgical biopsy. Also known as a wide local excision, wide local surgical biopsy and open biopsy, this type of biopsy is performed in the operating room at the same time as a lumpectomy. During the procedure, your surgeon will remove the mass of concern and an area of tissue surrounding it called a margin. A biopsy will be taken from the removed tissues and sent to the lab for analysis.
In some instances, if the mass is difficult to find, you may have a thin wire or other marking device placed in your breast prior to the surgery by a radiologist so your surgeon can easily locate the affected area during your procedure.
Your surgeon will provide you with specific instructions on how to prepare for your breast biopsy. In general, you will be asked to:
- Avoid using lotions, creams, powder, deodorant or perfume on your arms, breast, or armpits the day of your scheduled biopsy (unless otherwise instructed)
- Provide a list of medications you typically take to your care team, and potentially not take some of them prior to your procedure (your care team will advise what you can and cannot take)
- Fast prior to a surgical biopsy and arrange transportation home from the hospital or office
If you are having a fine-needle or core needle biopsy, you will likely experience a little discomfort. Most of the discomfort is from the insertion of the local anesthesia. You may experience some pressure during the actual biopsy, but it should not hurt. It is possible to have some bruising at the site. If you experience any discomfort following the procedure, typically an over-the-counter pain medication should help.
If you are having a surgical biopsy, you will not feel the actual procedure since you will be under general anesthesia. You may have some discomfort upon waking and for a short time while you recover after your surgery. Over-the-counter pain medication and ice packs may be recommended for the first 24 hours. However, your care team will advise you on what you should expect after surgery.
In general, breast biopsies are safe and, in many instances, non-invasive. Most people recover well from them. As with any medical procedure, there is a possibility of complications, including infection. In very rare instances, complications could include a collapsed lung, or blood being trapped between the chest wall and lungs.
Some common side effects following a breast biopsy may include:
- Changes in the look and feel of the breast, depending on how much tissue was removed
Your care team will advise on any additional side effects you may experience, as well as how long you should expect to have them.
Recovery time from a breast biopsy will depend on the type of biopsy that was performed. In most instances, if you had a non-invasive biopsy, you should plan to take it easy for 24 to 48 hours afterwards.
If you had a surgical biopsy, your recovery time will be longer. In most cases, you can expect recovery to take one to two weeks, but your surgeon will advise on appropriate recovery timelines.
A pathologist will report on the results of your breast biopsy to your surgeon. Typically, biopsy results are available within one to two weeks after your procedure, and your care team will schedule a follow up appointment to discuss your results.
Depending on the biopsy findings, your report may include:
- A description of your sample - such as color and consistency of the tissue
- A description of the cells - and if they visibly appear to be cancerous
- Cancer grading - which provides information on how the cancerous cells differ from the noncancerous cells, as well as how fast they are growing
- Recommendations for additional testing, if appropriate
Should you be diagnosed with cancer, your care team will work with you to create an individualized plan, tailored to your needs and goals.
Breast biopsies are covered by most insurance plans. However, contact your specific insurance carrier to learn what is covered in your individual situation
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