If your mammogram shows related results, your doctor may suggest a breast biopsy. While it can be worrying, remember that only 20% of breast biopsies reveal cancer. Biopsies are critical because they ensure prompt treatment of cancer is detected.
There are different types of breast biopsies, including fine needle aspiration, core needle biopsy, and surgical biopsy. The choice depends on factors like the size, appearance, and location of the suspicious area.
This article explains various breast biopsy methods and provides details on what to expect before, during, and after the procedure. You’ll learn about preparation, any discomfort you might experience, and how to understand the results.
What’s the Reason Behind My Doctor Recommending a Breast Biopsy?
A breast biopsy helps confirm breast cancer and determine its stage. Your doctor may recommend it if imaging tests like mammogram, ultrasound, or MRI suggest potential cancer signs, or if you have symptoms like lumps, breast changes, pain, nipple issues, or swollen lymph nodes.
Some signs that might prompt a breast biopsy include:
- A noticeable lump, whether hard or soft.
- Swelling in any part of the breast.
- Skin changes resembling an orange peel (dimpling or puckering).
- Pain anywhere in the breast, including the nipple.
- An inverted (inward-turning) nipple.
- Changes in the breast or nipple skin, like redness, flaking, thickening, or dryness.
- Nipple discharge that’s bloody or unrelated to breastfeeding.
- Swelling in the armpit or around the collarbone, near lymph nodes.
- A sensation of warmth or heaviness in the breast.
What Techniques Are Utilized for Breast Biopsies?
In a breast biopsy, they take tiny tissue samples or fluid to check for cancer cells in a lab. You’ll be informed in advance about the type of biopsy, allowing you to get ready. Sometimes, alongside the breast biopsy, your doctor might also perform a lymph node biopsy.
Fine Needle Aspiration
Fine needle aspiration is a simple, outpatient procedure using a thin needle attached to a syringe to collect fluid or breast tissue from a suspicious area. It’s often used for painful breast cysts, and if the mass is hard to feel, ultrasound guides the needle. Usually, only topical numbing is required to minimize discomfort, and general anesthesia isn’t necessary. You’ll be awake during the 20 to 30-minute procedure.
Core Needle Biopsy
Core needle biopsies are outpatient procedures performed with a local anesthetic, commonly used when breast cancer is suspected. Your provider will numb the area with a thin needle and may make a small cut in the breast tissue. They’ll then use a hollow needle to extract cylinder-shaped tissue samples, guided by imaging tools like ultrasound, breast MRI, or mammogram.
Stereotactic biopsies, guided by mammograms, involve compressing the breast for imaging before the procedure. These biopsies don’t require general anesthesia, so you’ll be awake during the test. While core needle biopsies are relatively fast, they usually take more time than fine needle aspirations.
Surgical (Open) Breast Biopsy
Surgical biopsies, usually performed in hospitals, are outpatient procedures. Although not commonly used for breast biopsies, they might be recommended if needle biopsies yield unclear results. In surgical biopsies, a scalpel and other tools are used to cut and remove all or part of the suspicious area, which is then examined under a microscope in a lab to check for cancer cells.
During a surgical biopsy, a section of normal breast tissue will be taken alongside the suspicious area to check for cancer spread if malignancy is present.
If the surgeon can’t locate the suspicious mass by touch, a localizing device like a wire or radioactive seed may be inserted into the area before the biopsy. This step is called preoperative localization.
Imaging tests assist the surgeon in accurately placing the localizing device just before or in advance of the biopsy procedure.
Before the biopsy, you’ll receive a local anesthetic in your breast, and you’ll be given IV sedation to make you drowsy. Sometimes, deep sleep through general anesthesia may be used instead. Both options ensure you won’t feel pain during the biopsy.
Skin Punch Biopsy
A skin punch biopsy, a less common procedure, is used when there’s suspicion of inflammatory breast cancer (IBC), which accounts for only about 3% of all breast cancers.
During this outpatient procedure, a small sample of breast skin and tissue beneath it is taken using a hollow, round-tipped scalpel. It’s a quick process, usually lasting around 15 minutes, and is typically done in a healthcare provider’s office or an ambulatory care facility. A local anesthetic is applied to numb the skin before the procedure, and sometimes, one or two stitches may be required to close the surgical wound.
How Long Do Breast Biopsies Take?
The duration of the biopsy procedure varies depending on the type:
- Punch biopsies: About 15 minutes.
- Fine needle biopsies: Typically 20 to 30 minutes.
- Core needle biopsies: May extend to an hour or more, especially if imaging is involved.
- Surgical biopsies: Can take two hours or more, including recovery time.
What Does a Breast Biopsy Feel Like in Terms of Pain?
During any biopsy procedure, you should experience minimal to no pain. During needle biopsies, you might feel some discomfort or pressure as the needle enters your skin. If imaging devices are used on your breast, you may also feel some pressure from the device.
For surgical breast biopsies, you will either be sedated or under deep anesthesia, ensuring you don’t feel pain during the procedure.
Caring for Yourself after a Breast Biopsy
Here are some self-care tips to follow after the procedure:
- Keep the bandage on for a full day; you can shower once it’s removed.
- If surgical paper tape was applied, leave it on for three days or until it falls off; avoid removing it for bathing.
- To reduce swelling and bruising, apply an ice pack for 10 to 15 minutes several times a day for one or two days.
- If necessary, take over-the-counter pain medication.
- Apply pressure to the excised area if bleeding occurs; persistent bleeding should be reported to your healthcare provider.
- Consider wearing a snug bra for support and comfort.
- Avoid heavy lifting or strenuous exercise until you’ve fully healed.
Follow-Up to Make a Treatment Plan
If you’re diagnosed with breast cancer, more tests are necessary to identify the type, aggressiveness, and stage of the cancer. The aim is to create an effective treatment plan, which could involve choices like lumpectomy or mastectomy, chemotherapy, and radiation. You can also discuss breast reconstruction with your surgeon. While it’s a challenging and frightening period, take time to process the information. Seeking a second opinion is an option, and connecting with others who’ve been through this experience can be beneficial when you’re ready.
Liquid biopsies are non-invasive tests using bodily fluids like blood, urine, and saliva to detect and monitor cancer. They can find circulating tumor DNA, RNA, proteins, and other markers. Liquid biopsies are used for various cancers but have limits; they’re not precise enough for cancer screening, can yield false results, and can’t locate the cancer’s exact location. Still, they offer less invasiveness, repeatability, and insight into cancer genetics. However, they may lead to extra tests, delays, or incorrect results and can be costly, with insurance coverage varying. Liquid biopsies typically involve a blood draw or urine collection, and results take days or weeks.