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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