Finding a lump in your breast can be a scary experience and you naturally want to have a diagnosis as soon as possible. Fortunately, around 80% of breast lumps are benign and, with today’s modern techniques, the procedure used to make the diagnosis, called a breast biopsy, is usually minimally invasive and can be done in less than half an hour under local anaesthesia. We speak to Dr Lim Siew Kuan, a general surgeon specialising in breast surgery, to discover the types of breast biopsies available and what to expect during and after the procedure.

What are the different types of breast biopsies and how they are performed?

A breast lump biopsy obtains tissue from the lump for assessment under a microscope. Common breast biopsy procedures include core biopsy, vacuum-assisted biopsy and open surgical biopsy. Imaging equipment like ultrasound and mammogram may be used to guide the biopsy.

What is a core biopsy?

In a core biopsy, the breast lump is first located by imaging, then local anaesthesia is injected around the lump to numb the area. Your surgeon will then make a tiny incision in the skin so that a spring-loaded needle can be inserted several times to obtain some tissue from the breast lump.

What is a vacuum-assisted biopsy?

A vacuum-assisted biopsy (VAB) is similar to a core biopsy, but uses a larger needle with a vacuum to pull the tissue into the device. More tissue can be taken in a single insertion and this procedure is often used to remove small breast lumps rather than just taking a sample. Like the core biopsy, a VAB is a minimally invasive procedure, thus causing minimal or no scarring.

What is an open surgical biopsy?

An open surgical biopsy is the conventional way of removing the entire breast lump, and this is done as a day surgery procedure under general anaesthesia. There will be a longer scar, but this procedure allows the most complete removal of larger breast lumps.

How do you decide which procedure best suited for your patients?

It depends on the size and nature of the lumps, and whether there is a decision to remove a lump during the procedure. For tiny lumps (< 5mm) or complex cysts (solid component in fluid), the core biopsy may not be able to obtain good tissue samples while a VAB allows more accurate placement of the needle and better tissue sampling for these lesions. If the lump is causing symptoms of discomfort, and removal is required even if the lump is benign, I will do an open surgical biopsy to remove the lump directly.

Does a breast biopsy hurt?

You will feel slight discomfort as the local anaesthesia is administered, similar to having a vaccination. However, you shouldn’t feel pain during the biopsy procedure itself. If you do feel pain, you should inform the doctor, who will immediately pause the procedure to administer additional local anaesthesia.

Are there parts of the breast that are more difficult to perform biopsy than others?

Yes, there are. These are typically areas too high up in the armpit, and too close to the chest wall or skin. This is especially true for biopsies done under stereotactic guidance, which uses low-dose x-rays to locate a breast abnormality and to obtain tissue samples for examination. It is technically challenging to place the needles in the correct position, or to obtain adequate tissue samples without injuring the chest wall or skin. In order to evaluate lumps which are hard to reach with stereotactic biopsy, an ultrasound-guided breast biopsy will be preferred. If a breast lump cannot be found using the ultrasound, then open surgical biopsy will be the procedure of choice.

Should women expect some bruising and skin discolouration from the procedure? Are there any general restrictions or home care instructions after a breast biopsy?

You can expect some bruising, but this should resolve in about 1 - 2 weeks. As the breast will be slightly sore in the week following the biopsy, you should refrain from strenuous activity during this period. Mild painkillers will be given and you should take them as required. Let your doctor know if you experience any significant breast swelling.

How soon should a patient expect to receive results of a biopsy?

The results of the biopsy will be ready within a week.

How often are breast biopsies positive for cancer?

Only 20% of all breast biopsies are positive for cancer. The remaining 80% of the patients who undergo biopsies do not have cancer.

Is there anything else that you think women need to know about breast biopsies?

Breast biopsies are usually straightforward procedures, performed with minimal risk. How your breast lump is treated thereafter depends on the biopsy results. When the tissue is benign, and the findings are consistent with the imaging, no further treatment is required. However, if cancer cells are found, you will need to undergo further cancer surgery and treatment, even if the entire lump was removed during the biopsy. Another possibility could be that the biopsy result reveals the presence of ‘high risk’ or atypical cells, which may be associated with surrounding cancer cells. This will usually be deemed inconclusive and you will be required to undergo an open surgical biopsy to get a conclusive diagnosis.

Article contributed by Dr Lim Siew Kuan, general surgeon at Mount Elizabeth Novena Hospital