Excision biopsy of a breast lump

An excision biopsy of a breast lump involves removing a lump through a small cut.
Usually no other breast tissue or lymph nodes (glands) are removed. The tissue will be
examined under a microscope to find out if you have cancer.

Your surgeon has recommended an excision biopsy because:

• You want to have the lump removed for cosmetic reasons, or because the lump is
causing you pain
• Your surgeon is concerned about the lump and other procedures such as a fine
needle aspiration or core needle biopsy have failed to give a definite diagnosis.

Benefits

The surgeon will be able to remove the lump in your breast and confirm, after examining
the tissue under a microscope, whether or not you have cancer. If you do have cancer
your surgeon will be able to recommend the best treatment for you. If the lump is caused
by cancer, early diagnosis and treatment will increase the chances of recovery.

Alternatives

If the lump is probably benign and less than about 2cm (1in) across, it may be possible to
remove it using a special needle called a mammotome. However, a mammotome excision
is only available in a few specialist centres.

The operation

If your surgeon can’t feel the lump, a breast radiologist (doctor who specialises in breast
X-rays and scans) will use a mammogram machine or ultrasound scanner to guide the
surgeon to where the lump is. Guidewire may be placed into your breast using a local
anaesthetic or, if the lump is close to the skin, a pen will be used to mark the position of
the lump.

An excision biopsy is usually performed under a general anaesthetic and takes about 30
minutes. Your surgeon will go through the breast gland and remove the lump. They will
usually close the wound with dissolvable stitches.

For more information, and if you have any queries about the operation, speak to your
consultant.

Continue your normal medication unless you are told otherwise.

The following lifestyle changes can help make the operation a success:
 • Giving up smoking
• Eating healthily. If overweight, you have a greater chance of developing
complications
• Exercising regularly. Your GP can recommend exercises

Possible complications

• Bleeding after surgery. It is common to get bruising of the breast or chest area
• Some pain is common with most operations
• Infection of the surgical wound – this usually settles with antibiotics, but further
surgery may be required
• Unsightly scarring of the skin, particularly if the wound gets infected
• Continued lumpiness under the wound. It is normal for the wound to feel lumpy,
but this should settle within four to six weeks
• Ongoing pain. The operation may not stop this pain
• Change of feeling in the nipple area, which is rare and should settle on its own

This is not a definitive list and symptoms will vary with each patient. Please ask your
consultant for more information.

Recovery

You should be able to go home the same day after the operation. However, your doctor
may recommend that you stay a little longer. Remember, you will not be able to drive
home after your operation.

Wearing a soft bra that fits comfortably will help to support your breast and reduce any
pain, and you should be able to have a bath or shower 24 hours after the operation. Avoid
soaking the wound too much for the first five days.

You should be able to return to work after three to seven days and most women return to
normal activities within ten days. Ask your GP for advice on gentle exercise.

You’ll be asked to attend a follow-up clinic within three weeks after your operation
where results of the biopsy will be discussed and plans of any treatment or follow-up you
may need.

Paying for your operation

Excision biopsy costs are covered by most medical insurance policies, but please check
with your insurer first. If you are paying for your own treatment the cost of the operation
will be explained and confirmed in writing when you book the operation. Ask the
hospital for a quote beforehand, and ensure that this includes the surgeon’s fee, the
anaesthetist’s fee and the hospital charge for your procedure.
What Are Fibroadenomas?:
A benign (non-cancerous) breast tumor that is made of glandular and fibrous breast
tissue. Fibroadenomas are very common in premenopausal women, and they can occur in
groups. These lumps feel solid and smooth, and are usually not troublesome.

Treatment or Removal of Fibroadenomas:

Since fibroadenomas are benign, treatment will vary depending on your diagnosis. If it is
small, painless, remains the same size, and a biopsy shows no problems, you would not
need further treatment, but may have follow-up ultrasounds. However, if it is large (more
than three cm), painful, growing, or a biopsy results in atypical (very active) cells, you
can have it surgically removed with a lumpectomy. If you qualify, you can have
fibroadenomas removed with a laser ablation (using heat) or cryoablation (freezing). In-
situ ablation of fibroadenomas can be done in-office, leaves tiny scars, and has fast
recovery.
What Causes Fibroadenomas?:
The exact cause of fibroadenomas is unknown. They seem to be influenced by estrogen,
because they appear most often in premenopausal or pregnant women, or in women who
are postmenopausal and taking HRT (hormone replacement therapy). Most
fibroadenomas come and go during your menstrual cycle, when your hormone levels are
changing.
When Do Fibroadenomas Appear?:
These are most common in women who are from 15 to 30 years old and in pregnant
women. Fibroadenomas occur in 10 percent of all women, but in 20 percent of African-
American women. They are much less common in postmenopausal women, unless the
women is on estrogen therapy. About 10 percent of all fibroadenomas will disappear over
time, and twenty percent of them will recur. If they don’t disappear, they usually stop
growing when they reach two or three cm.