Breast Disease and Breast Biopsy
Breast Biopsy Techniques
When an abnormality is detected in the breast, either by examination or mammogram, a
biopsy is often recommended. There are a variety of biopsy techniques available. Your
surgeon will choose the biopsy approach that is most appropriate for you, based upon the
nature and location of the abnormality. Some abnormalities will require a surgical approach
for complete evaluation, while others may be evaluated with a needle biopsy.
Stereotactic (Mammotome) Biopsy
A needle biopsy (either a fine needle aspiration biopsy or a core needle biopsy) involves
placing a needle into the abnormal area to remove a small amount of tissue for analysis. If
there is a lump that can be felt, your surgeon may be able to do this type of biopsy in the
office. If the abnormality is not palpable, or if it is deep in the breast, a needle biopsy can
be done using either ultrasound guidance or as a stereotactic biopsy. The ultrasound, or
stereotactic mammogram images, allows for precise placement of the needle into the center
of the abnormality. A needle biopsy is done using local anesthesia, takes very little time,
and is usually associated with only mild discomfort.
Stereotactic (Mammotome) Biopsy
When an abnormality can only be seen by mammogram, a stereotactic core biopsy may be
done. (This is sometimes called a Mammotome biopsy, which is the brand name for the
equipment.) This is a biopsy done with a special, automated needle that is placed into the
breast using a sophisticated computer guidance technique based upon mammogram
images. The stereotactic biopsy equipment is located in the Breast Imaging section of the
Radiology Department at Hartford Hospital. If this is the biopsy procedure that is
recommended for you, an appointment will be made to have this done at Hartford Hospital.
What To Expect During A Stereotactic Biopsy
During the examination, the lights in the room will be dimmed and you will be asked to lie
on your stomach on a specially designed table. There is an opening in the table to allow
your breast to be placed through the opening. The procedure is performed using a
mammogram machine mounted underneath the table. Initially several localizing
mammograms will be obtained to confirm the location of the area to be biopsied. Then local
anesthesia will be given, and the biopsy performed. Usually several samples are obtained in
the area. With each sampling you will hear a click and feel a bit of pressure. Most women do
not feel a significant amount of pain during this procedure. Overall the procedure should
take about one hour.
After A Needle Biopsy
You can expect some discomfort, bruising, and swelling after a needle biopsy. For most
patients these are mild symptoms. Applying ice to the breast (on and off, no more than 30
minutes at a time) can help reduce bruising and swelling. You may use Tylenol (2 tablets
every 4 hours) or Ibuprofen (1 tablet every 4 hours) for the discomfort. Most women also
find that a supportive sports-type bra makes them more comfortable for the first 24 hours
(overnight). It is usually not necessary to restrict your activities after a needle biopsy of the
breast. As long as you feel well, you may resume your normal schedule. You can expect the
bruising to resolve in 5 to 7 days.
Surgical Biopsy
A surgical biopsy is done when a breast lesion should be removed or if a needle biopsy
cannot provide enough tissue for analysis. A surgeon, in the operating room does this type
of biopsy. An incision is made on the breast, and the abnormal tissue is removed in order to
accurately diagnose the abnormality. It is called a "biopsy" because all tissue removed is
sent for analysis, even though in most cases the entire lesion is removed.
A surgical biopsy is an outpatient procedure. Your surgeon will decide which type of
anesthesia is most appropriate in order to keep you comfortable during the biopsy
procedure. It can be done using local anesthesia, local anesthesia combined with
intravenous sedation, or general anesthesia. If you have intravenous sedation or general
anesthesia, you will spend some time in the recovery room before you are allowed to go
home.
Risks and complications of a surgical breast biopsy include infection, bleeding, bruising,
hematoma (a blood clot in the area of the surgery), and seroma (a fluid collection in the
area of the surgery). There may also be a change in the appearance of the breast as a
result of the procedure.
Needle Localization (Wire Localization)
If the abnormality to be removed is too small to be felt on examination, the surgical biopsy
will be done with needle localization. Needle localization, sometimes also called wire
localization, is done in the radiology department just before your scheduled surgery. The
radiologist identifies the abnormal tissue using mammograms, ultrasound or MRI (whichever
technique shows it best). Using local anesthesia, the radiologist inserts a small needle into
the area of concern. The location of the needle is confirmed, and then a thin, flexible wire is
passed through the needle. The needle is removed, and the wire is taped to your breast.
One final set of mammograms is taken to demonstrate that the wire is located in the correct
area. You are then sent to the Operating Room, along with the pertinent x-rays, for your
surgical biopsy. Your surgeon uses the wire, and the x-rays, to locate the area to be
removed.
How To Prepare For A Breast Biopsy
THE WEEK BEFORE PROCEDURE:
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Unless otherwise directed by the nurse or doctor. DO NOT TAKE ASPIRIN OR
IBUPROFEN (such as Motrin), Vitamen E or any other medications that thin the
blood. See medication guidelines for surgery.
Do not take any herbal or diet medication prior to surgery. It is recommended that
you stop using these two weeks before surgery.
THE DAY BEFORE SURGERY:
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Unless otherwise directed by the nurse or your doctor, DO NOT EAT OR DRINK
ANYTHING AFTER MIDNIGHT.
PLANNING YOUR DISCHARGE - Things to consider before your Admission
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You will be discharged the same day as your surgery.
Following surgery, it is not uncommon to experience some weakness,
lightheadedness, or sleepiness.
We encourage you to arrange childcare during and after your hospital stay.
We encourage you to arrange for transportation on your day of discharge. A
responsible adult must drive you home.
Following surgery, you must not drink alcohol, drive or make important decisions for
24 hours.
After a Surgical Biopsy (With Or Without Needle Localization)
You can expect some bruising, swelling and pain after a surgical breast biopsy. You will also
feel tired.
There is always some pain after surgery, although each patient has a different experience.
You will be given a prescription for pain medication. You may also take ibuprofen or Tylenol
for mild or moderate discomfort. Ice applied to the breast during the first day after surgery
can help reduce pain and swelling. Most patients feel more comfortable wearing a bra.
The day after surgery you may remove the gauze bandage and shower. You may get the
incision wet, and then pat dry. It is best to avoid baths, hot tubs, and swimming for a week.
The steri-strips will start to curl up and fall off in 7-10 days.
You may resume most normal activities as soon as you feel able. You will want to avoid
jogging and jumping for at least a week, as the bouncing of your breasts will be very
uncomfortable. Most patients are more comfortable wearing a bra after a breast biopsyeven to sleep. You should not drive if you are still taking pain medication!