“I recommend a breast biopsy.”  As a health-conscious woman, you got your yearly mammogram, but it resulted in a callback for additional breast imaging.  Or perhaps you felt a lump or had new breast symptoms, and just finished your diagnostic exam.  Now this…..a breast biopsy?!

Even the most calm and level-headed women feel a surge in stress when they receive a recommendation for breast biopsy.  What does it mean to have a biopsy? Does this mean I have cancer?  What’s involved?  Will it hurt?  When will I know the results?  All of these questions – and the anxiety about the biopsy process that comes along with them – are normal and expected.  Let’s address these concerns one-by-one, and help you through this common procedure.

What is a breast biopsy?
A breast biopsy is a minimally-invasive procedure that involves taking very small samples of tissue directly from the area of greatest concern on the breast imaging test.  Some people refer to this test as a “needle biopsy” because a special type of hollow needle called a core biopsy needle is used to obtain the samples.  There are multiple ways to perform a breast biopsy, but the most common, accurate, and least invasive methods use imaging technology such as ultrasound, mammography, or breast MRI to confirm that the biopsy needle is in the right place when the sample is obtained.

If I need a breast biopsy, does it mean I have cancer?
Not necessarily.  I always find it gives my patients comfort to know this fact: of all the breast biopsies performed in the United States in the course of a year, over 70% of them are negative for cancer.  So chances are higher than average that your breast biopsy results will not reveal cancer.  This occurs because there is substantial overlap in the way benign and cancerous lesions can appear on breast imaging tests, and the primary goal of breast imaging is to prove that early breast cancer is not present.  So a lot of breast biopsies are performed across the country for breast findings that are indeterminate: meaning they are not definitely cancer, but also aren’t definitely benign.  The goal is to completely exclude the presence of early, treatable, and, most importantly, curable breast cancer.

What’s involved in a breast biopsy procedure?
All breast biopsy procedures performed with imaging guidance are outpatient procedures and require no sedation.  This means you can drive yourself to and from your biopsy appointment.  You can – and should! – eat as you normally would before the procedure.  Almost all of your normal medicines can be taken as prescribed prior to your breast biopsy.  The only medicines we ask you to hold, if possible, are aspirin and aspirin-containing products for one week and nonsteroidal anti-inflammatory medicines (NSAIDs) like ibuprofen or naproxen for 2-3 days.  If you cannot hold these medicines, it’s no problem; we will still perform your breast biopsy. But just know you may have a higher likelihood of bruising and hematoma formation after the procedure.

During all imaging-guided breast biopsies, the skin of the breast is sterilized and local anesthetic is injected with a very small needle to numb the tissues needing the biopsy.  After the area is numb, a 2-3 mm incision is made and the core biopsy needle is placed in the area of concern.  Multiple (on average 4-6) small samples of tissue are acquired, each about 1-2 cm in length and the size of a thin spaghetti noodle.  The area of the biopsy is marked with a tiny clip made of surgical titanium, the incision is closed with an adhesive dressing (no sutures necessary), and the procedure is all done.

Although you will be at the facility for around an hour, most breast biopsy procedures take 15 minutes or less.  The majority of the time will be spent in discussing the procedure and getting everything set up.

Will it hurt?
Not much!  There will be a small pinch and a brief (<10-15 second) burning sensation at the beginning of the procedure while the tissues are being numbed.  After that, you will feel some pressure in the breast, but you should not experience any sharp pain or significant discomfort during the biopsy. If you need extra reassurance (who doesn’t?), let me share that the comment I hear most often immediately after breast biopsy is: “That wasn’t as bad as I thought it was going to be.”

All patients will leave from the procedure with a compression dressing.  We ask you to wear the dressing for one day to decrease your likelihood of significant bruising or hematoma formation and to help immobilize the breast tissues after biopsy so that you can start healing immediately.  The compression dressing along with ice applied to the biopsy site will also significantly decrease any symptoms of discomfort in the area of biopsy after the anesthesia wears off.  Most patients have minimal soreness in the breast during the first 24 hours after the biopsy, but the combination of the compression dressing, ice, and Tylenol (if needed) effectively and completely treat these symptoms.

When do I get my results?
In five business days or less.  The breast biopsy samples are placed in fixative and sent to pathology physicians that specialize in breast disease.  The tissue samples will undergo special staining and microscopic evaluation to arrive at a diagnosis.  As soon as the pathology report is available, an ACC doctor will call you or meet with you in person to discuss your results, answer your questions, and give you a personalized plan of care.

As always, if you or a loved one have any questions or concerns about your breast health, please don’t hesitate to contact the Ackerman Cancer Center Women’s Imaging team.