Breast Biopsy

What is a breast biopsy?

A breast biopsy is when a healthcare provider takes a sample of your breast tissue to examine under a microscope. You may have this procedure if a healthcare provider believes changes in your breasts could be breast cancer.

A breast biopsy is the only way a provider can rule out breast cancer. You may feel anxious or fearful about having the procedure. But it’s important to remember that having a biopsy doesn’t mean you have breast cancer. In fact, 80% of females who have a breast biopsy don’t have cancer.

What does it mean if you need a breast biopsy?

Healthcare providers usually order breast biopsies after imaging tests show results that might be signs of breast cancer. For example, a provider may order a breast biopsy if:

• You or your provider feels a lump or thickening inside your breast, which may happen when you check your breasts
• A mammogram shows an abnormal area in your breast
• A breast ultrasound shows an area of your breast that your provider thinks could be cancer
• You have unusual changes in your nipple or areola (the darker-colored skin that surrounds your nipple), like crusting, dimpling skin or unusual discharge

What are the types of breast biopsies?

Different types of breast biopsies involve different procedures. Your healthcare provider will recommend the type that’s best for you, given what they already know about the changes in your breast. The different types are:

• Fine-needle aspiration (FNA) biopsy. A radiologist will do the procedure, using a syringe with a thin needle to remove fluid and tissue from your breast.
• Core needle breast biopsy. Radiologists typically do core needle biopsies. This biopsy type uses a slightly larger needle than an FNA biopsy. The larger needle means your radiologist can get more breast tissue than the amount of tissue that an FNA removes.
• Excisional breast biopsy (lumpectomy). This is surgery to remove all potentially cancerous tissue in the area where tests found abnormalities. Your surgeon may also remove some of the normal tissue that surrounds the abnormal area. They do this to make sure they get all the cancer cells.
• Incisional breast biopsy. Your surgeon removes only a part of the abnormal tissue in the targeted area.

How do I prepare for a breast biopsy?

If you’re undergoing a breast biopsy, it’s important to let your healthcare provider, surgeon and/or radiologist know if:

• You’re pregnant or there’s a chance you’re pregnant
• You take blood-thinning (anticoagulant) medication, because your provider may adjust your medication before the biopsy to prevent excess bleeding or bruising
• You take aspirin or herbal supplements
• You have any health conditions or have recently had surgery
• You have any allergies, especially to anesthesia that you receive during the procedure

Your care team will explain other steps, like whether you should use deodorant on the day of your surgery or if you’ll need someone to take you home after the biopsy.

What happens before a breast biopsy?

Your provider may do procedures to pinpoint the area of your breast that they’ll check for signs of cancer. For example, they may do image-guided procedures or a wire localization procedure.

Image-guided procedures

You may have different types of imaging tests just before your breast biopsy. Your provider may refer to this as image-guided procedures since they’ll use the imaging machines during the biopsy. Types of image-guided procedures are:

• Stereotactic breast biopsy
• Ultrasound-guided biopsy
• Magnetic resonance imaging (MRI)-guided biopsy

Wire or non-wire localization procedure

If you’re having a surgical biopsy, your surgeon may do a wire localization procedure. This involves placing a thin wire in your breast that your surgeon uses to guide the biopsy. They may do this procedure the day of your surgery. A wire localization involves the following:

1. Your anesthesiologist will use a very tiny needle to inject medication that will numb the area of your breast where your surgeon will insert the wire.
2. Using an imaging test like an ultrasound or MRI, your surgeon will place a thin, hollow needle into the biopsy area.
3. Once the tip of the needle is in the correct spot, your provider will insert a thin, sterile wire through the center of the needle. The wire has a small hook at the end of it to keep it in place.
4. Your surgeon will remove the needle, leaving the wire in your breast. The end of the wire is outside of your breast.
5. They’ll remove the wire after completing the biopsy.

Your surgeon may use other preoperative localization procedures. These procedures involve placing tiny devices into the targeted area of your breast. They may use:

• Tiny, radioactive pellets that give off a very small amount of radiation
• Tiny, magnetic pellets that create small magnetic fields
• Tiny radiofrequency reflectors that give off a signal that your provider can see using a special device they hold over your breast

Your surgeon will use a handheld detector to guide excision.

What to expect during a breast biopsy

Your experience will be different depending on the type of breast biopsy that your healthcare provider does:

• If you’re having a fine needle aspiration biopsy, your provider will give you local anesthesia. Then, they’ll insert the needle into your skin to get fluid and tissue samples.
• If you’re having a core needle breast biopsy, your radiologist will give you local anesthesia. They may make a tiny cut (incision) in your breast to insert the needle they’ll use to get tissue samples. Then, they’ll place biopsy markers in the biopsy area. The markers help them locate the biopsy area in case they need to get more tissue samples for examination.
• If you’re having surgery like a lumpectomy or excisional biopsy, your anesthesiologist will give you general anesthesia. Your surgeon will make incisions (cuts) in your breast to remove tissue samples. They’ll close the incisions with stitches and a sterile bandage.

How long does a breast biopsy take?

The procedure times vary depending on the biopsy type:

• Fine needle aspirations may take 10 to 15 minutes.
• Core needle breast biopsies may take 20 to 60 minutes, depending on the imaging process that your radiologist uses.
• Excisional breast biopsies (lumpectomies) may take up to 60 minutes.
• Incisional breast biopsies may take 60 minutes to complete.

How long does it take to recover from a breast biopsy?

Everyone is a bit different, but in general, if you had fine-needle aspiration with local anesthesia, the biopsy area may hurt, and you may want to take it easy for the rest of the day. You should be able to get back to your normal activities the next day.

If you have a core needle breast biopsy, your provider may recommend that you avoid strenuous activity for at least two days.

If you’ve had a surgical biopsy, you may have pain in the biopsy area that lasts for a few days. It could take a couple of days to a week before you can return to your normal activities. The recovery time depends on factors like the size of the incision and how much breast tissue your surgeon removed.

What are the risks of a breast biopsy?

There are some common risks and side effects, including:

• Bruising
• Bleeding
• Swelling
• Pain or soreness
• Surgical wound infection

Contact your surgeon if you experience surgical wound infection symptoms. For example, a fever that’s greater than 101 degrees Fahrenheit (38.4 degrees Celsius) is a reason to call your surgeon.

What are the complications of a breast biopsy?

Breast biopsy complications are very rare. Potential complications are:

• Bleeding that leads to a breast hematoma
• Infection
• Collapsed lung (pneumothorax)
• Hemothorax (blood collects between your chest wall and your lungs)
• Hemopneumothorax (you have a collapsed lung and blood collects between your chest wall and your lungs)

What type of results do you get and what do the results mean?

If you had a fine-needle aspiration biopsy, a medical pathologist will do cytology tests. The tests help the pathologist rule out cancer or determine if there are cancerous cells in the abnormal area of your breast. The possible results range from no evidence of abnormal cells to precancerous cells or cancerous cells.

If you had a core needle biopsy, excisional biopsy or incisional biopsy, the pathologist will determine if you have a noncancerous (benign) breast disorder, if some tissue is cancerous or if a lump of tissue removed during the biopsy is a cancerous tumor.

What happens if biopsy results show you have cancer?

If tests detect a cancerous tumor, the pathologist will give your provider a report that notes:

• The tumor type. A tumor can be invasive or noninvasive. An invasive tumor is likely to spread to nearby breast tissue or may spread to other parts of your body. A noninvasive tumor typically doesn’t spread.
• The tumor grade. Setting a tumor grade is part of the cancer staging system. Pathologists check to see how quickly cancer cells are dividing and how much cancerous cells look like normal cells.
• Hormone receptor status. Tumors need hormones to grow. Pathologists do tests to see if a tumor expresses (releases) hormones and is a hormone-receptor positive tumor. Estrogen receptor-positive (ER+) breast cancer is a common breast cancer subtype.
• HER2 status. Some people with invasive breast cancer have HER2-positive cancer. HER2 stands for human epidermal growth factor receptor 2. HER2 is a protein that helps cancer cells grow and spread.

Your provider will share the test results with you and explain what they mean. They may discuss treatment options.

When should I know the results of the test?

It usually takes one to two weeks for your biopsy results to come back. Waiting for biopsy results can be stressful. Your healthcare team understands that and will be glad to answer your questions. Following your regular routine, doing things that you enjoy and sharing your feelings with others may help.

When should I call my doctor?

Call your surgeon if you experience infection symptoms like:

• Fever
• The skin around the biopsy site is red or darker than your skin color
• The site is painful to the touch
• You develop significant bruising that’s spreading

Are breast biopsies painful?

No, but you may feel:

• A slight poke or pinch from a needle injection or IV insertion when you receive anesthesia
• Pressure if you have a fine-needle aspiration or core needle biopsy

What conditions cause symptoms that are similar to breast cancer?

Several types of benign breast disease may cause symptoms that look and feel like breast cancer, including:

• Benign breast tumors. Fibroadenoma is the most common type of noncancerous (benign) breast tumor.
• Breast calcification. Breast calcifications are small clusters of calcium deposits that form in your breast tissue.
• Cysts. Breast cysts are fluid-filled sacs that can become painful. You can usually move them around under your skin.
• Fibrosis. Fibrosis happens when your breast tissue thickens and feels firm in different areas. Hormone changes often cause fibrosis.