What are the other Names for the Procedure?
- Biopsy - Breast
- Excisional Breast Biopsy
- Open Breast Biopsy
What is Breast Biopsy by Excision surgical procedure?
Breast Biopsy by Excision is a surgical procedure that involves the removal of abnormal tissue, from within the breast.
What part of the Body does the Procedure involve?
An Excisional Breast Biopsy procedure involves the affected breast.
Why is the Breast Biopsy by Excision surgical procedure Performed?
Breast Biopsy by Excision is performed whenever an abnormality is suspected in the breast, which is diagnosed either through palpation, or by imaging studies (like ultrasound, mammogram, CT scan, or MRI scan).
What are some Alternative Choices for the Procedure?
Some of the alternative techniques used include:
- Ultrasound-guided FNA (fine needle aspiration of the cells from the suspected area). The FNA is performed with a smaller diameter needle
- Ultrasound-guided core needle biopsy, where the needle used is of larger diameter
- Stereotactic core needle biopsy: Biopsy performed using a needle, with the guidance of mammography
- If the patient’s abnormality can be felt with the fingers (on a physical exam), a FNA or biopsy may be performed, without the aid of any imaging guidance, such as an ultrasound or mammogram
What are the Recent Advances in the Procedure?
Various sophisticated biopsy forceps, which make the procedure lesser invasive, are being increasingly available in the market.
What is the Cost of performing the Breast Biopsy by Excision surgical procedure?
The cost of Breast Biopsy by Excision procedure depends on a variety of factors, such as the type of your health insurance, annual deductibles, co-pay requirements, out-of-network and in-network of your healthcare providers and healthcare facilities.
In many cases, an estimate may be provided before the procedure. The final amount depends upon the findings during the surgery/procedure and post-operative care that is necessary.
When do you need a Second Opinion, prior to the Procedure?
- It is normal for a patient to feel uncomfortable and confused by the information regarding Breast Biopsy by Excision and on what needs to be done
- If the patient needs further reassurance or a second opinion, a physician will almost always assist and also recommend another physician, if required
- They can also choose to approach another physician independently. Besides, if the procedure has many alternatives, the patient may take a second opinion to understand and choose the best one
What are some Helpful Resources?
Complete Guide to Symptoms, Illness & Surgery; Written by H Winter Griffith, M.D.; Revised and updated by Stephen Moore, M.D. and Kenneth Yoder, M.D.; The Berkley Publishing Group, 5th Edition, New York, 2006
Prior to Breast Biopsy by Excision surgical procedure:
How is the Breast Biopsy by Excision surgical procedure Performed?
- A Breast Biopsy by Excision surgical procedure is performed under local or general anesthesia
- The patient is taken to the radiology suite, where the abnormal area is first localized with an imaging technique (typically using a mammogram). A long needle with its tip adjacent to the suspected area, is left in place
- In the operating room then, the surgeon makes an incision on the breast, alongside the needle, or adjacent to the areola (area around the nipple)
- The incision is then made deeper and the breast tissue surrounding the needle tip excised. The whole specimen with the needle in place, is then sent for radiological study
- Specimen imaging is then performed, which confirms whether the suspected area is adequately excised or not
- Once this is confirmed, the surgeon closes the incision with sutures
- The individual is usually discharged, the same day
Where is the Procedure Performed?
A Breast Biopsy by Excision is performed in a hospital or an out-patient surgery center facility. The patient is admitted, undergoes the procedure, and is discharged as per the instruction of the physician.
Who Performs the Procedure?
Breast Biopsy by Excision is performed by general surgeon, with assistance from an anesthesiologist.
How long will the Procedure take?
The procedure typically takes less than an hour.
What do you need to tell your Physician before the Procedure?
It is very important to provide the following information to your healthcare provider. This enables your healthcare provider in assessing the risks for the surgical procedure and helps avoid unnecessary complications.
- Provide a complete list of medications you are currently, taking to your physician. This information is useful for a variety of reasons. For example, it can help your healthcare provider prevent complications due to a drug interaction
- If you are allergic to any specific medication or food items
- If you are taking blood thinners, such as aspirin, warfarin, herbal supplements, or any other such medications
- If you or your family members, have a history of bleeding disorders, or if there is a tendency to bleed more than normal
- If you have diabetes, high blood pressure, chest pains, or have previously suffered from a heart attack
- If you have ever been diagnosed with blood clots in your leg (deep vein thrombosis) or lung (embolism of lung)
- If you have a history of frequent bone fractures (this may affect bone-healing, if bones are involved as part of your procedure)
- A list of all previous surgical procedures you have undergone, like for example: Removal of appendix, gallbladder, or any other part, of your body; surgical repair of any body part, such as hernia repair, perforation of bowel wall, etc.
What Preparations are needed, prior to the Procedure?
- The physician may evaluate the individual’s medical history to gain a comprehensive knowledge of the overall health status of the patient including information related to the medications that are being currently taken
- Some medications increase a person’s chances of bleeding and it may be recommended to discontinue them for a period of time, before the procedure is performed
- Blood tests may be performed to determine if there is a bleeding tendency or any other medical conditions that prevents the person from undergoing the procedure
- Inform the physician if you are allergic to any local anesthetics, lidocaine, etc.
- Avoid application of any cosmetics, deodorant, or topical medicines on the area, prior to the procedure
- It is advisable to quit smoking and the use of any nicotine based products, for a while, before the surgery
- Consumption of alcoholic drinks must also be avoided for a period of time, as instructed
- The patient must avoid eating or drinking at least 8 hours prior to the surgical procedure, depending on when the procedure is arranged
- For persons suffering from diabetes, it is important that the blood sugar stays within the normal range; if not their diabetologist may have to control blood sugar by recommending insulin and/or a combination of oral medicines
- A physician will request your consent for the Breast Biopsy by Excision procedure using an Informed Consent Form.
What is the Consent Process before the Procedure?
A physician will request your consent for the Breast Biopsy by Excision procedure using an Informed Consent Form.
Consent for the Procedure: A “consent” is your approval to undergo a procedure. A consent form is signed after the risks and benefits of the procedure, and alternative treatment options, are discussed. This process is called informed consent.
You must sign the forms only after you are totally satisfied by the answers to your questions. In case of minors and individuals unable to personally give their consent, the individual’s legal guardian or next of kin, shall give their consent for the procedure.
What Tests are needed, before the Breast Biopsy by Excision surgical procedure?
Several tests may be necessary prior to Breast Biopsy procedure. These could include:
- Blood test
- Urine study
- Ultrasound scan
- The physician may suggest further tests depending on the health of the patient and their medical history.
What are some Questions for your Physician?
Some of the basic questions that you might ask your physician are as follows:
- What is a Breast Biopsy by Excision procedure?
- Why is this procedure necessary? How will it help?
- How soon should I get it done? Is it an emergency?
- What are the alternatives to the procedure?
- Who are the medical personnel involved in this procedure?
- Where is the procedure performed?
- What are the risks while performing the procedure?
- What are the complications that might take place, during recovery?
- How long will it take to recover? When can I resume normal work?
- How many such procedures have you (the physician) performed?
- Are there any follow-up tests, periodic visits to the healthcare facility required, after the procedure?
- What are the costs involved?
During the Breast Biopsy by Excision surgical procedure:
What kind of Anesthesia is given, during the Procedure?
Local anesthesia or general anesthesia is administered during the procedure.
How much Blood will you lose, during the Procedure?
Since Breast Biopsy by Excision is a less invasive procedure, there is little or no blood loss involved.
What are the possible Risks and Complications during Breast Biopsy by Excision surgical procedure?
There are general factors that increase the risk of getting complications during the procedure, which include:
- Obesity: Generally greater the degree of obesity, greater is the surgical risk
- Smoking: Longer the smoking history (in pack years smoked), greater the surgical risk
- Recent or chronic illness
- Poorly controlled diabetes, as evidenced by a high hemoglobin A1c and a high fasting glucose
- Poor nutritional status (malnutrition with mineral and vitamin deficiencies)
- History of bleeding disorders
- Poor immune system due to a variety of causes
- The possible risks or complications that may arise during the surgery are:
- Excessive bleeding
- Anesthetic complications
- Accidental injury to neighboring tissue
What Post-Operative Care is needed at the Healthcare Facility after Breast Biopsy by Excision surgical procedure?
At the healthcare facility, generally there is no requirement for any post-procedure care, unless any complications arise.
After the Breast Biopsy by Excision surgical procedure:
What are the possible Risks and Complications after the Breast Biopsy by Excision surgical procedure?
Post Breast Biopsy by Surgical Excision, the following complications may arise:
- Excessive bleeding surrounding the incision site
- Signs of infection surrounding the surgical wound
- In rare cases, unsightly visual appearance of the scar on the breast contour
- Anesthetic complications
What is the Prognosis after the Surgery?
- The prognosis is based on the final pathology report
- Benign conditions tend to have good prognosis compared to cancers
- If cancer is confirmed, then prognosis is based on the stage of cancer, at the time of diagnosis
When do you need to call your Physician?
Do contact your physician if you notice any of the following symptoms:
- Worsening pain surrounding the surgical wound
- Bleeding or fluid drainage around surrounding the surgical wound
- Signs of infection
- Muscle aches
- Feeling sick
- Complications associated with prescription medications used for the treatment
What Post-Operative Care is needed at Home after the Breast Biopsy by Excision surgical procedure?
At home, the following post-operative care is recommended after an Excisional Biopsy of the Breast:
- Do not drive until the narcotic pain medication effect wears off. Narcotic medication can cause drowsiness, which may result in impaired driving
- Use heat pad or warm compress on the incision, to relieve pain
- Keep the wound clean and dry
- Resume regular/daily activities, as early as possible (under advice by the physician). This aids in a faster recovery
- Avoid sex till complete healing has taken place (under advice by the physician)
- Avoid all activities that are physically strenuous, for a period of 2 weeks
- Complete the course of prescribed medication (under advice of the physician)
- Avoid taking nonprescription medications, such as aspirin. However, individuals may take acetaminophen, to relieve pain, if necessary
- Wear a supportive bra (and a loose-fitting one), before bedtime
How long does it normally take to fully recover, from the Procedure?
It takes about 1 to 2 weeks to fully recover from the procedure.
What happens to tissue (if any), taken out during the Procedure?
The tissue is taken for further examination and later disposed, as per the standard medical procedure.
When should you expect results from the pathologist regarding tissue taken out, during the Procedure?
- The tissue removed is processed in the laboratory under a pathologist's supervision
- Slide(s) are prepared once the tissue is processed and is examined by a pathologist and a pathology report issued
- Depending on the complexity of the case, issue of the report may take anywhere between 72 hours to a week's time
Who will you receive a Bill from, after the Breast Biopsy by Excision surgical procedure?
It is important to note that the number of bills that the patient may receive depends on the arrangement the healthcare facility has with the physician and other healthcare providers.
Sometimes, the patient may get a single bill that includes the healthcare facility and the consultant physician charges. Sometimes, the patient might get multiple bills depending on the healthcare provider involved. For instance, the patient may get a bill from:
- The outpatient facility, physician’s office or hospital
- An anesthesiologist (if anesthesia was administered)
- A pathologist (if the tissue was sent for analysis)
- A general surgeon
The patient is advised to inquire and confirm the type of billing, before the Breast Biopsy by Excision procedure is performed.
Thanks and Gratitude:
We sincerely acknowledge and thank Dr. Douglas J. Jones for reviewing the article. His valuable input and feedback has helped enrich the contents of this article.
Douglas J. Jones, MD FACS
Board Certified General Surgeon and Faculty Member
University of Illinois, College of Medicine at Urbana-Champaign
506 S. Mathews Ave., Urbana, IL 61801, USA