Date issued: January 2018
For review: January 2020
Ref: B-397/Breast care/MJ/Vacuum excision biopsy v2
You have been advised to undergo a vacuum excision biopsy of an area in the breast. This area will have been biopsied already, and based on this biopsy result further tissue removal has been recommended to you.
This excision biopsy will remove a larger sample of tissue to either, (1) make a more confident diagnosis, or, (2) remove a small probably benign lesion found on original biopsy.
This leaflet aims to answer some of your questions.
What is a Vacuum Excision Biopsy of the breast?
This is a minimally invasive procedure that does not require admission to hospital, or general anaesthetic, or open surgery.
This procedure removes a small area of tissue inside the breast under local anaesthetic (just numbing a small area of the breast, not putting you to sleep). The procedure is very similar to the ultrasound biopsy that you underwent. However with this procedure the area of concern is sucked into the needle until we can no longer see it. The sample of tissue is sent to the pathologist for analysis. There is no special preparation for this test and you may eat and drink normally.
Why is it done?
Your mammogram (breast x-ray)/ ultrasound of the breast highlighted an area, which had a core biopsy needle test performed on it. This did not show cancer but we need to remove more tissue to confirm that the area is benign and requires no further treatment.
Sometimes a small lesion has been found and this procedure can remove it.
In the past the only way to test the tissue, or remove these very small lesions, was to undergo an operation under a general anaesthetic.
However, we can now perform a simpler test as an outpatient; under local anaesthetic (you stay awake). If only innocent tissue (benign) is removed during the excision biopsy, no further action is usually required and an operation can be avoided. However, if any abnormal or malignant cells are found an operation may be necessary.
How is it done?
- The procedure is done using ultrasound. You will be asked to undress to the waist and lie on a couch. You will be covered so only the area for the procedure is exposed. There will be a number of people in the room; the person performing the procedure will be either a Consultant Radiologist or Consultant Radiographer. There will be a Radiographer looking after the biopsy equipment and a Healthcare Assistant to take care of you.
- Ultrasound gel is applied to the skin of the breast. The ultrasound probe will run over your skin to locate the area we wish to remove.
- Local anaesthetic is given and, when the skin is numb a very small cut is made, just big enough to put the needle into the area of interest in the breast. The needle is attached to a suction device.
- You may hear a sound similar to the whirring of a sewing machine, while the sample is drawn out by the vacuum suction device.
- When the sample has been taken, the needle will be removed and the Radiographer/ Healthcare Assistant will apply pressure to the biopsy site for 5 – 10 minutes to prevent bleeding and reduce bruising.
- Steri-strip wound closures and plaster are then applied to the biopsy site. An information leaflet on aftercare of the biopsy site will be given to you.
How long does the test take?
It may take approximately 30 minutes. However we will ask that you remain in the department after the test for 15 – 30 minutes before you leave, in order that we can check that any post excision biopsy bleeding has settled, and you are well enough to leave.
The clinician may ask for consent to leave a tiny metallic marker in the breast. This is sterile and harmless and acts as a marker in case surgery is needed later. The surgeon can then use the marker as a guide to remove the correct piece of tissue. It can be safely left in the breast if no operation is required. It causes no harm. It will not set off metal detectors.
Will it hurt?
The local anaesthetic may sting a little at first but once it has taken effect and numbed the area, there is little further discomfort. If you have had a problem with local anaesthetic before, or if you take any anticoagulation medication, mention this to the doctor.
This test may be slightly uncomfortable but is not usually painful. You may feel pressure or discomfort in the biopsy area as the samples are being taken. Infrequently, there is oozing of blood from the biopsy site, which usually responds to pressure over the area. Very rarely, the surgeon may need to insert a superficial stitch. There is likely to be some bruising after the procedure, which does not usually cause a problem and will settle on its own. A supportive bra is advised. Mild painkillers may be helpful.
No admission to hospital / no general anaesthetic required / smaller incision.
There is a small risk of bruising / haematoma / infection.
We will contact you when the results are available from the pathology laboratory and the situation will be discussed further during a clinic appointment. You may wish to bring a relative or friend with you.
If you have any concerns or require further information please contact your breast care nurse. Tel No: 01752 431898 (if answerphone, please leave message and a nurse will return your call)