This procedure can be performed whether or not the breast mass is palpable and is usually performed under local anesthesia (i.e., the patient remains awake during the procedure). The area is numbed with a local anesthetic and a sedative is usually administered. A small incision of about 1 to 2 inches is made as close to the lump as possible. The surgeon removes a piece of tissue, or if it is small, the entire lump and the incision is sutured. The biopsy usually takes about an hour to perform.
If the lump cannot be felt, the procedure is slightly more involved and time consuming. Because it cannot be felt, it must be located by a process called needle localization. The patient goes to radiology and a mammogram is used to pinpoint the lump. A wire needle is inserted into the breast, marking the location of the lump. The wire is left inside the breast and taped to the skin, and the patient is taken to the operating room to have the biopsy.
Open Excisional Breast Biopsy Preoperative Procedures
This type of biopsy is usually done on an outpatient basis. Many biopsies are performed at surgical centers. If it is done at the hospital, the patient usually goes to an area for outpatients prior to surgery.
If the patient is taking medication that "thins" the blood, including aspirin, they should speak to the physician about it as soon as the decision to do the biopsy has been made. It is common for blood thinners to be discontinued several days prior to a scheduled operation to avoid abnormal bleeding during the procedure.
The patient must sign an informed consent form acknowledging that the procedure and potential risks have been explained.
Some patients receive a sedative prior to the procedure through an intravenous (IV) or by injection.
Open Excisional Breast Biopsy Postoperative Care
Following the procedure, the patient goes to the recovery room and is monitored by the nursing staff. Recovery from a biopsy done under local anesthesia is generally rapid.
Postoperative pain is usually minimal and resolves within a few days. However, pain medication may be prescribed. The patient may return to work the day after biopsy, if their job is not physically demanding. For 1 to 2 weeks following the procedure, heavy lifting should be avoided. The incision should completely heal within 1 month, and the stitches dissolve or are removed a week to 10 days later at the doctor's office.
The effects of sedation can wear off very quickly or may take several hours. The patient must be accompanied home after the biopsy and may still be very groggy.
Strenuous activity should be avoided for the first 2 or 3 weeks following the biopsy to prevent bleeding. Stitches should be kept dry to prevent infection, and sponge baths may be recommended until they are removed.
Many patients are anxious about the cosmetic appearance of their breast following biopsy. The incision leaves a small scar that fades in time. The location of the lesion, its size, and the amount of surrounding tissue removed determines whether or not the breast changes in appearance. For example, if a very large lump was removed, the scar may be large and may leave an indentation in the breast.
Open Excisional Breast Biopsy Postoperative Complications
Few complications are associated with biopsy. Infection can occur, and the incision site should be watched for redness, swelling, or fluid leakage that should be reported to the physician immediately.
All surgery causes internal scarring. Scar tissue can interfere with readings of future mammograms.