Surgical Breast Biopsy

If exams or imaging tests show you might have breast cancer, your healthcare team will often recommend a breast biopsy to help find out for sure. Most of the time this will be a core needle biopsy (CNB) or a fine needle aspiration (FNA). About 1 out of 10 people who need a breast biopsy need a surgical biopsy.

What is a surgical biopsy?

For a surgical biopsy, sometimes called an open biopsy, surgery is used to remove all or part of an abnormal area so it can be checked for cancer cells.

There are 2 types of surgical biopsies:

• Incisional biopsies remove only part of the abnormal area.
• Excisional biopsies remove the entire tumor or abnormal area. A margin (edge) of normal breast tissue around the tumor might be removed as well.

Marking the abnormal area before surgery (preoperative localization)

If the change in your breast can be felt, the surgeon can do the biopsy using their sense of touch as a guide.

But if the change cannot be felt or is hard to find, an imaging test such as a mammogram, ultrasound, or MRI might be done before the surgery to help place a wire or another localizing device into the suspicious area. This can help guide the surgeon to the right spot. This is called preoperative localization.

Wire localization

For wire localization, your breast is numbed, and an imaging test is used to guide a thin, hollow needle into the abnormal area. Once the tip of the needle is in the right spot, a thin wire is put in through the center of the needle. A small hook at the end of the wire keeps it in place, while the other end of the wire remains outside the breast. Then, the needle is removed.

Once the wire is in, you are taken to the operating room with the wire in your breast, and the surgeon uses the wire as a guide to the area to be removed. When this method is used, it is done the same day as your surgery.

Other methods

In newer methods of localization, a localizing device is put into the suspicious area before the day of your surgery. Methods include:

• Radioactive seeds, tiny pellets that give off a very small amount of radiation
• Magnetic seeds, tiny pellets that create small magnetic fields
• Radiofrequency reflectors, small devices that can be detected by a device held over the breast

Unlike wire localization, these can be placed completely inside the breast. Your surgeon can find the suspicious area by using a handheld detector in the operating room.

What to expect if you have a surgical biopsy

Most often, a surgical biopsy is done in a hospital’s outpatient department or a surgical center. In rare cases, it might be done in the doctor's office.

During a surgical biopsy

Surgical biopsies are most often done under anesthesia, including:

• Local anesthesia (numbing medicine), along with IV sedation to make you drowsy.
• General anesthesia, where you’re given medicine to put you in a deep sleep and not feel pain.

The skin of the breast is cut and the doctor removes the suspicious area. You will likely need stitches after a surgical biopsy, and pressure might be applied for a short time to help limit bleeding. Then, the area is covered with a sterile dressing.

After a surgical biopsy

The biopsy can cause bleeding, bruising, or swelling. This can make it seem like the breast is larger after the biopsy. Most often, this is nothing to worry about, and the bruising and swelling will go away over time. You will get instructions on how to care for the biopsy site, how much you might need to limit your activities and for how long, and when you might need to contact your care team.

A surgical biopsy might leave a scar. You might also notice a change in the shape of your breast, depending on how much breast tissue is removed.

Getting the results

A doctor called a pathologist will look at the biopsy tissue under a microscope to check it for cancer cells. Ask your care team when you can expect to get the results of your biopsy. The next steps will depend on the biopsy results.

If no cancer cells are found in the biopsy, your doctor will talk to you about whether any other tests are needed, as well as when you need to have your next mammogram and any other follow-up visits.

If breast cancer is found, other lab tests might be done on the tissue to learn more about the cancer and how best to treat it. Your doctor will talk to you about these tests and about what the next steps will be. You might need to see other doctors, too. To learn more, see Understanding a Breast Cancer Diagnosis.