Open Surgical Breast Biopsy

Most breast lumps are benign. In fact, 4 out of every 5 breast lumps are not cancerous. If you have a breast lump and want it checked out, a surgical biopsy is a good way to get a clear diagnosis. This type of breast biopsy removes the largest size of the tissue sample, as compared to any type of needle biopsy. Surgical biopsy is done in a hospital, with a general anesthetic, and is usually an outpatient procedure.

• Open surgical biopsy
• Breast biopsy
• Partial mastectomy
• Excisional breast biopsy

An open surgical breast biopsy is needed if the results of a needle biopsy are unclear or if a lump is so hard that a needle cannot obtain a good tissue sample. Also called a "partial mastectomy," a surgical biopsy is done to remove a tissue sample that is larger than a sample from a core needle or vacuum-assisted biopsy. In some cases, the entire mass and a margin of healthy tissue may be removed. The tissue will be examined in a lab right away to ensure that it is an accurate sample and to get a diagnosis.

For a breast mass that is easy to locate by touch, your surgeon may use mammograms or ultrasound and palpation to locate the tissue for a biopsy. If your mass is quite small or hard to find by touch, you may have a wire localization done prior to your biopsy. This is done while you are awake, and local anesthesia is used to numb your breast. Using mammography, a hollow needle is guided into your breast mass, and a thin wire is fed through the needle to that location. The wire is left in place to help guide your surgeon to the right spot for your biopsy.

You will be prepared for surgery and given a general anesthetic, which will put you to sleep. Your surgeon will make an incision over the mass to be biopsied and locate the mass using touch or wire localization. Small masses may be removed entirely, but in most cases, a slice of the mass will be taken and sent to the lab. When there is enough tissue for a clear diagnosis, your incision will be closed with stitches and dressed. You will be taken to the recovery room to sleep until the anesthetic wears off. You will be able to go home the same day, but someone else must drive for you.

A surgical biopsy will result in a small scar on your breast skin. Be sure to keep your surgical dressing dry until you have gone for your follow-up visit. Take a full day to recover from your biopsy, as you may have some residual anesthetic in your system. If you have pain at the biopsy site, it's OK to take ibuprofen and use a cold pack.

A pathology lab can use two methods to study your tissue sample. The quickest method is called "frozen section" or cryosection. The tissue is rapidly frozen and sliced with a special blade into a section thin enough to see through. This gives a diagnosis of benign or malignant, but no other details. A permanent section is a more thorough process, using special chemicals to get more information from the tissue slide. This process takes about 48 to 72 hours and gives a bigger picture of your diagnosis: if it is malignant, you can find out if it is hormone sensitive and whether it is a high or low grade.

When you awaken from surgery, you may be told your preliminary biopsy results. If your mass was benign, then you won't need any further surgery. If your diagnosis was malignant (cancerous), though, you will need to wait two or three days to get your full pathology results. Your doctor will meet with you to explain the details of your diagnosis, but you won't need to rush into treatment. Take your time to study all of your options before deciding on a treatment plan. Remember, you are still the same person you were before your biopsy — having breast cancer does not define you!

Surgical breast biopsy takes the largest tissue sample and has the highest accuracy rate of all biopsy methods. On the other hand, some disadvantages may be the need for stitches to close your incision and the resulting scar and internal scar tissue that will appear on future mammograms. In a few cases, patients develop bleeding and infection at the biopsy site or have a bad reaction to the anesthesia. Be sure to ask your doctor if a surgical biopsy will really work best for you or if other methods, such as core needle biopsy or vacuum-assisted breast biopsy, would be good alternatives

At one time, a surgical biopsy and a breast cancer surgery were one process. A woman having a lump suspicious for a breast cancer would go in for a surgical biopsy knowing that if the tissue removed and tested while she was in the operating room proved to be cancer, the surgeon would then perform the necessary surgery. The woman would awake to find out if she had cancer, and if she had a lumpectomy or a mastectomy. Today, the two-step process of having a biopsy and cancer surgery, if indicated, are two separate procedures. If the biopsy is negative, the woman's worst fears are behind her. If the biopsy is positive, she has the time to prepare emotionally and to make preparations for her recovery time and possible post-surgical treatments such as radiation and/or chemotherapy. 

Edited by: Jean Campbell, MS