Breast Biopsy

What is a breast biopsy?

This is a procedure done to remove all or part of a breast lump for examination under a microscope. Most of the time the entire lump is removed, but on occasion, if the lump is very large, only remove part of the lump. The area removed is given to a doctor called a pathologist who examines it under a microscope. He will tell us what the lump is.

For a rapid diagnosis, the pathologist can quick-freeze a portion of the lump and make very thin slices which he can look at under the microscope. This only takes about 15 minutes and is called a frozen section. This is only done if we make a specific request for a frozen section. This can give us a diagnosis about 98% of the time.

Occasionally, the pathologist has to say that he is not sure of the frozen section diagnosis, and that we will have to wait for the permanent sections, which take two days to process. This takes longer because instead of freezing the tissue, it is imbedded in paraffin (or wax). This process gives a clearer microscopic slide.

Sometimes the appearance of the lump, once it is removed, is very obviously benign even without a frozen section. In these cases we usually do not do a frozen section because of the added expense. Certain kinds of lumps, particularly lumps that seem to be composed mostly of fat cells, do not freeze well and frozen sections are not possible. Some lumps are so small that the pathologist is reluctant to use up the small amount of tissue for the frozen section and risk not having enough for the more definitive permanent sections.

It is possible to proceed with additional breast surgery on the same day if the biopsy should turn out to be malignant, but there is no proven medical reason why they both have to be done on the same day.

What is the operation like?
A breast biopsy is usually done with local anesthesia (lidocaine or novocaine) plus some sedation if needed. General anesthesia (asleep) is used for very large lumps or more complicated procedures. A breast biopsy is usually done as an outpatient, which means that you will come to the hospital the morning of the operation, have the surgery, and go home later in the day. You will need someone to drive you home after the operation. The operation itself begins with an incision over the lump. All, or part, of the lump is removed, and the incision closed. The lump is sent to the pathology laboratory for examination. Most of the time we will have a diagnosis before you go home.

After the operation
The site of the breast biopsy may be mildly uncomfortable during the days immediately following the operation. Usually Tylenol or aspirin provide adequate pain relief. If the biopsy is for an unusually large lump, Tylenol with codeine, Vicodin, Darvon, or a similar pain reliever may be prescribed. Discomfort and swelling can be minimized if you bring a good support bra to the hospital with you and wear it immediately after the operation. Most patients wear a bra day and night for the first five to seven days after the operation for this reason. In most situations, patients can plan to resume normal activity the day after the biopsy.

We usually close the skin incision with dissolving sutures. You will not be able to see them, because they are beneath the skin. There will be some Steri-Strip tapes across the incision. Over these will be a gauze dressing or Band-Aid. The outer dressing can be removed 48 hours from the operation. The Steri-Strips should be left in place for seven to ten days. The longer they stay in place the better the scar will look. It is OK to get the incision wet 48 hours after the surgery. There is no real restriction on your activity after the operation, except to avoid any direct injury to the biopsy site.

Problems with breast biopsy
Often there is some bruising of the breast after the surgery. Because of gravity, the bruising will sometimes settle in the lowest area of the breast. This will usually disappear after the first one to two weeks. You may feel a firmness in the breast at the site of the biopsy for several months after the operation. This is a result of the sutures placed in the breast after the lump is removed, along with normal scar formation. This usually resolves as the scar softens and the sutures dissolve.

What about the results of the biopsy?
Any report or impression that are obtained on the day of surgery will have to be confirmed by the permanent section report which will be available a few days later. Occasionally, the pathologist has to do additional tests on the slides, or has to send them elsewhere for another opinion. If that happens, it can delay the report for about a week.