From my breast biopsy onward, I have encountered medical procedures and terminology that I was unfamiliar with. Sometimes the unknown is the scariest part, so I created this post to demystify the breast biopsy.
Most women would be alarmed if told that a suspicious area in their breast needed to be biopsied, but they shouldn’t be. About 80-85% of the time, a breast biopsy detects a benign condition related to fibrocystic changes. This is a catch-all term for a variety of changes in the breast that produce lumpiness or irregularities. Fibrocystic changes are not a risk factor for breast cancer. However, detecting and treating breast cancer early can yield a better prognosis, so it is a good idea to follow through with a breast biopsy if your healthcare provider recommends one.
What is a breast biopsy?
A biopsy removes some tissue from the suspicious area so that a pathologist can examine it under a microscope and determine whether it is cancerous. Biopsies are performed either with a needle or surgically. Needle biopsies may also use imaging techniques such as ultrasound, stereotactic mammography or MRI to locate the lump.
With ultrasound, a gel is placed on the breast and the ultrasound probe is held up to that area while the doctor or surgeon inserts the needle. With stereotactic mammography, you lie on your stomach on a table with a hole in it. Your breast goes in the hole and they use mammography to image the breast from various angles and identify the location of the lump. This is like getting a mammogram, except you are lying down. With an MRI guided biopsy, you will also lie on a table and your breast will hang through an opening. You will get an IV line in your arm where they will insert a contrast chemical. Depending on the MRI machine used, you may have to lie very still inside of a tube. So if you are claustrophobic or don’t like tight spaces, let them know when scheduling your biopsy. MRI guidance is sometimes also used with surgical biopsies to insert a thin wire that guides the surgeon to the lump.
Fine Needle Aspiration Biopsy
Fine needle aspiration is the least invasive of the biopsies because it uses a very fine needle attached to a syringe to remove a sample of breast tissue. If the lump is difficult to locate, an ultrasound may be used to guide the needle. This procedure is good for determining if the lump is a fluid-filled cyst or solid. If it is a cyst, it may be drained during the procedure. If it is solid, a second biopsy may be needed to collect a larger specimen.
Core Needle Biopsy
Core needle biopsy is similar to the fine needle aspiration but the needle is larger. It extracts larger samples of tissue, so it will provide clearer results. Local anesthesia is used to numb the area. Then, about five samples of tissue are extracted. After the biopsy, the area may be bruised but there should be no scarring. Stitches are not necessary. Instead, steri-strips or a bandage will seal off the wound.
The core needle procedure can be combined with ultrasound, stereotactic mammography, or MRI to help locate the mass. A core needle biopsy may also be combined with a vacuum-powered device to extract tissue. After numbing the area, a small cut (about ¼ inch) is made in the skin, the needle is inserted, the vacuum pulls tissue into the needle, and a rotating knife cuts the tissue that will be removed. This procedure does not require stitches but produces a little scarring.
After all the samples are taken, a small clip made of surgical grade metal will probably be inserted into the area. This will help identify the area that was biopsied on future mammograms or biopsies.
This is the most invasive of the biopsy procedures, but it provides the most information about the lump. It is typically done at a hospital as an outpatient procedure, and it can involve local or general anesthesia. There are two types of surgical biopsies. An incisional biopsy removes part of the mass, whereas an excisional biopsy removes the entire mass. Surgical biopsies require stitches and will produce some scarring. Depending on the size of the lump, an excisional biopsy may alter the shape of your breast.
Preparing For a Breast Biopsy
If you are having a surgical biopsy, your doctor will give you specific instructions for how to prepare and care for yourself after the procedure. If you are having general anesthesia, you will need to fast beforehand. You will also need somebody to drive you home.
Fine needle aspirations may or may not require local anesthesia because the needle is so thin. In fact, this procedure can take place in your doctor’s office. Usually, no special preparation is needed. However, you should tell your doctor if you have a bleeding disorder or are taking medications that thin your blood since these may cause bleeding following the biopsy.
Local anesthesia will likely be used for a core needle biopsy, so you don’t need to fast. This is the type of biopsy I had done, and I went to a radiology center for it. It may also be done at a breast center, doctor’s office, or wherever the equipment is located. If possible, you should stop taking any blood-thinning medications five days before. On the day of the biopsy, wear a top with buttons or zipper closure on the front and a tight bra without underwires.
The procedure itself lasts about 20 minutes, but once you account for the time it takes to fill out paperwork and prepare the area for the biopsy, everything will take about 1.5 – 2 hours.
You should clarify specifics with your doctor and ask any questions you may have beforehand. For example:
Which type of biopsy is your doctor recommending? Why?
If your doctor recommends a surgical biopsy, why is this method preferred to a needle biopsy?
When and how will you receive the biopsy results?
How should you prepare for the biopsy?
Should you stop taking any medications before the procedure?
Will you need a driver to take you home after the procedure?
Should you limit your activities following the procedure?
Will you experience any pain or scarring?
Will the shape of your breast change?
What are the possible complications from the procedure?
After the Biopsy
Following a core needle biopsy, you are queen for a day! I was instructed to do the following:
- Have somebody drive me home after the procedure.
- No heavy lifting or vigorous exercise after the biopsy, but resume normal activities the next day.
- Wear a tight bra for 24 hours (including at night).
- Apply ice to the area 20 minutes on, 40 minutes off for 3-4 hours to help with the swelling.
- Take Tylenol or Ibuprofen if needed for pain.
- Do not get the area wet for at least 24 hours.
- Remove the steri-strips in 3-4 days, and don’t scrub the area until the strips come off.
- Report any bleeding, drainage, excessive, swelling, redness or heat.
If you are really sensitive to pain, you may want to take the painkiller right after you get the biopsy done. I didn’t, and I was in a little bit of pain afterward but it was manageable. Also, I was bruised for about a week.
For most people, the hardest part will be waiting for the biopsy results. Try to remember that 80 – 85% of the time, the results are not indicative of cancer. You may want to minimize your anxiety by talking about your situation with somebody or doing something you enjoy to distract yourself. I’ve found it helpful to spend more time with my children when I’m feeling anxious. There’s just something calming about letting yourself go into the world of little ones.
If you’ve ever had a breast biopsy, how was your experience? How did you cope with waiting for the results?