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Item ID: MON220   Source ID: 2

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by Krisha McCoy, MS

Anatomy and Physiology
A woman's breasts are composed mostly of glandular tissue and fat. They also contain connective tissue, blood vessels, lymph vessels, and lymph nodes. The glands produce and secrete milk for breastfeeding an infant.

Changes in breast tissue are common. A woman's breast tissue changes over the course of her lifetime, as well as during her menstrual cycle or if she is taking hormones.

One type of breast change is the development of a lump or mass. Breast masses are often found upon self-examination or by a mammogram. They may be benign or cancerous. Most are not cancerous; about 80% of breast lumps that require a biopsy prove to be benign.

Reasons for Procedure
A breast biopsy is used to make a precise diagnosis of a mass or other suspicious area in the breast. In this procedure, a sample of tissue is removed so it can be examined in a laboratory. A breast biopsy is necessary to determine if a mass is cancerous.

Treatments
There are three basic types of breast biopsies: in an aspiration biopsy, a needle is used to withdraw fluid from inside a breast cyst. In an incisional biopsy, a sample of tissue is separated from the rest of the mass, which remains behind in the breast. In an excisional biopsy, the entire mass, plus a small amount of surrounding tissue, is removed. Breast biopsies are performed using one of four procedures: needle biopsy, stereotactic core biopsy, ultrasound guided core biopsy, or surgical biopsy.

Procedure
Depending on the technique used, breast biopsies may require a brief office visit or a more lengthy procedure in the operating room. In the days leading up to a more lengthy procedure: arrange for a ride to and from the hospital. Eat a light meal the night before and do not eat or drink anything after midnight. Ask your doctor about the need to temporarily discontinue or change the dose of any medications you take regularly. Do not start taking any new medications before consulting your doctor.

Most breast biopsies are done under local anesthesia. This means only the area of the biopsy will be numb during the procedure.

If your breast lump can be felt, your doctor may perform a needle biopsy, which can be done in the office. In a needle biopsy, a needle is inserted into your breast to remove fluid or sample the tissue.

If your breast lump was discovered on a mammogram and cannot be felt, your doctor may recommend a stereotactic or ultrasound guided core biopsy. In a stereotactic core biopsy, your doctor uses a mammogram and computer to guide a hollow needle into the lump and remove several cores of tissue for examination.

In an ultrasound guided core biopsy, your doctor locates the suspicious area with an ultrasound probe and inserts a hollow needle into the area to remove several cores of tissue for examination.

Your doctor may recommend surgery in the operating room to remove the entire lump. If your lump can be felt, he or she will perform an excisional biopsy by making an incision in your breast and removing the lump along with surrounding tissue. The incision is then stitched closed.

If your lump cannot be felt, a radiologist can use a mammogram or ultrasound to guide the insertion of a needle and wire into the suspicious area. Then your surgeon will perform an excisional biopsy of the targeted area. After the lump is removed, the incision will be stitched closed.

Risks and Benefits
Risks and complications associated with breast biopsy are rare. However, there is a chance that the following complications may occur: infection; excessive bleeding during or after the procedure; collection of fluid under the skin; local scarring.

Benefits of breast biopsy include: precise diagnosis of a suspicious area or lump in your breast; minimal invasiveness and associated complications.

In a breast biopsy or any procedure, you and your doctor must carefully weigh the risks and benefits to determine whether it's the most appropriate choice for you.

After the Procedure
After the Procedure: in most cases, little to no recovery time is necessary, excisional biopsies may require a day or two, tissue samples will be sent to a lab for testing, you will receive your results by phone or at a follow-up appointment. If you received stitches, they may need to be removed in several days. Once you are home, be sure to contact your doctor if you experience: a fever or chills, increased pain, warmth, or redness at the incision site, swelling that does not subside in a few days, excessive bleeding or discharge at the incision site, coughing, chest pain, or shortness of breath.

Sources:

  • Anesthesia: Options and Considerations. Mayo Clinic website. Available at: http://www.mayoclinic.com/invoke.cfm?id=SC00026. Accessed January 12, 2004.
  • Breast biopsy. Memorial Hospital of Rhode Island website. Available at: http://www.mhri.org/patient_information/patient_education/breast_biopsy_CONTAINER.htm. Accessed January 14, 2004.
  • Breast Biopsy Reference Summary. National Library of Medicine website. Available at:http://www.nlm.nih.gov/medlineplus/tutorials/_instruct/instructions.html?ModuleURL=breastlumpsbiopsy&LMModuleID=gs059101&x=92&y=12. Accessed January 12,2004.
  • How is Breast Cancer Diagnosed? American Cancer Society website. Available at:http://www.cancer.org/docroot/cri/content/cri_2_4_3x_how_is_breast_cancer_diagnosed_5.asp.Accessed January 12, 2004.
  • Understanding breast changes: a health guide for all women. National Cancer Institute website.Available at: http://www.cancer.gov/cancerinfo/understanding-breast-changes/. Accessed January12, 2004.
  • When You Find a Breast Lump. Mayo Clinic website. Available at: http://www.mayoclinic.com/invoke.cfm?objectid=32348DF9-B0D5-45B9-82D3247C1178ABA0. Accessed January 12, 2004.


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