Excisional
Biopsy of the Breast
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What is the
test?
In an excisional biopsy of the breast, the surgeon
makes an incision in the skin and removes all
or part of the abnormal tissue for examination
under a microscope. Unlike needle biopsies, a
surgical biopsy leaves a visible scar on the
breast and sometimes causes a noticeable change
in the breast’s shape. It’s a good
idea to discuss the placement and length of the
incision with your surgeon beforehand. Also ask
your surgeon about scarring and the possibility
of changes to your breast shape and size after
healing, as well as the choice between local
anesthesia and general anesthesia.
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How
do I prepare for the test?
You’ll undergo a breast exam and possibly
a mammogram before the biopsy to determine where
the lump is located. If you are having a sedative
with local anesthesia, or if you are having general
anesthesia, you’ll be asked not to eat
anything after midnight on the day before the
surgery.
Tell your doctor if you’re taking insulin,
NSAIDs, or any medicine that can affect blood
clotting. You might have to stop or adjust the
dose of these medicines before your test.
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What
happens when the test is performed?
A surgical biopsy is done in an operating room.
An IV line is placed in your arm so that you
can receive medicines through it. The doctor
may use local anesthesia with sedation to help
you relax during the procedure, or general anesthesia.
Surgical biopsies take about an hour, and the
recovery period is less than two hours.
An open biopsy that removes only part of a lump
of suspicious tissue is called an incisional
biopsy; one that removes the entire lump is called
an excisional biopsy. An incisional biopsy is
usually done when the lump is quite large, since
removing a larger lump completely can alter the
appearance of the breast. This procedure is appropriate
for larger lumps in order to secure a diagnosis
while minimizing the effect on the breast’s
appearance. If the tissue proves to be cancerous,
the remaining portion of the lump will be removed
surgically, usually during a second surgical
procedure that may be more extensive and involve
removal of lymph nodes to determine whether the
cancer has spread.
When a breast mass or an area of calcification
cannot be felt, the surgeon may choose to use
a procedure called wire localization to help
identify the tissue for later surgical biopsy.
The first part of this procedure is a mammogram.
After applying a local anesthetic, the doctor
inserts a hollow needle into the breast and,
guided by ultrasound or mammography, places the
tip of the needle in the suspicious area. He
or she then inserts a thin wire with a hook on
the end through the hollow needle and into the
breast alongside the suspicious area. The doctor
then removes the needle, leaving the wire in
place to serve as a guide to help a surgeon find
the area of breast tissue to be removed later.
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What
risks are there from the test?
Following a surgical breast biopsy, you’ll
have a short scar in the shape of a line. There
may also be some distortion in the shape of the
breast depending on its size, and the amount
of tissue removed and its location. Expect to
feel some soreness and swelling near the surgery
site for a few days. There are also some risks
associated with anesthesia, although the risk
of general anesthesia is lower for breast surgery
than for other forms of surgery, because the
anesthesia isn’t used for very long and
the surgery is only slightly more than skin deep.
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Must
I do anything special after the test is over?
Medical staff monitor you for a few hours after
your surgery to make sure that you’re recovering
well and not having any adverse reactions to
anesthesia. Contact your doctor if you develop
a fever, strong pain at the incision site, or
bleeding from the incision. You may need a follow-up
visit so that your doctor can remove stitches
and make sure you are recovering well.
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How
long is it before the result of the test is
known?
A preliminary report from the pathologist might
be available when your surgery is over. A final
report typically takes three to four days.
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