Display Patient Information Leaflets

Date issued: June 2026

Review date: June 2028

Leaflet section: Breast Care

PDF: Vacuum Excision Sampling of the Breast Under X-ray Guidance.pdf [pdf] 160KB

West Devon and East Cornwall Breast Screening Service

You have been advised to undergo vacuum excision/wider sampling of an area in your breast. This area will have been biopsied already and, based on this biopsy result, further tissue removal has been recommended to you.

In the past, this would have been done by an operation, requiring admission to hospital and a general anaesthetic. However, new guidelines now recommend that these types of breast change are removed, or more thoroughly sampled, using a vacuum needle technique under local anaesthetic as an outpatient procedure in the breast unit. The procedure will have already been discussed with you by a doctor or breast care nurse.

This vacuum procedure 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.

It is essential to know, prior to this procedure, if you are currently taking Aspirin or other tablets that thin the blood, such as Warfarin, Clopidogrel (Plavix) or Rivaroxaban (Xarelto). If you are, please contact us immediately, do not wait for your appointment.

This leaflet aims to answer some of your questions.

What is a Vacuum Excision/Sample of the Breast?

This is a minimally invasive procedure that does not require admission to hospital, 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 x-ray-guided/stereotactic biopsy that you have already undergone. However, with this procedure more tissue is removed, so the degree of bruising after the procedure is likely to be more. The samples of tissue are 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) highlighted an area, which had a vacuum 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. If the area is small, 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 (benign) tissue is removed during the procedure, 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. Depending on the results, the area may require monitoring by yearly mammograms.

How is it done?

The procedure is very similar to the x-ray guided biopsy you have already had done.

1. The person performing the procedure, which will be either a Doctor (Consultant Radiologist) or Consultant Radiographer, will speak to you after you arrive, to give you another explanation of the procedure, answer any questions you may still have, and take your consent for the procedure.

2. You will then be taken into the procedure room. There will be a number of people in the room: the person performing the procedure, whom you will already have met, a Radiographer looking after the x-ray equipment, and a Healthcare Assistant to take care of you.

3. You will be asked to undress to the waist. The Radiographer will help you to lie face down on a special table, making sure you are as comfortable as possible. Your breast will be positioned through an opening in the table. The table will be raised so that the Clinician can work from below.

4. A flat plate will be placed against the breast and the breast compressed. The amount of compression, however, will be less than that applied during your recent mammograms.

5. X-ray images are then taken to indicate the correct position from which to take the samples. It may be necessary to readjust the position of the breast several times to ensure that the area of interest is in our working window. Once the last set up picture has been taken it is very important that you keep as still as possible so that the breast does not move.

6. Local anaesthetic is given (which initially can be a little sharp and sting for a few seconds) and, when the skin is numb, a small opening is made.

7. You may hear a sound similar to the whirring of a sewing machine, while the samples are drawn out by vacuum suction.

8. When all the necessary samples have been taken, a marker clip will be placed at the site of sampling before the vacuum needle is removed from the breast.

9. The compression plate will then be removed, and firm pressure will be applied to the sample site for at least 15 - 20 minutes to try and prevent bleeding/subsequent bruising.

10. Steri-strips and a small dressing will then be applied over the small skin opening, followed by a pressure dressing.

11. Two mammograms will then be performed of the sampled breast. This will require you to be taken into an adjacent room. A pressure dressing will be applied after the mammograms.

12. You will then be asked to remain in the unit for a further 30 minutes such that we can check the dressing to ensure that any bleeding has stopped and that you are well enough to leave. An information leaflet on aftercare will be given to you.

How long does the test take?

You are likely to be in the unit for approximately 1 to 2 hours, but it could be longer if the procedure proves difficult. The sampling itself only takes up a small fraction of this time and should only be slightly longer than the biopsy you have already had. A large part of the time is taken up in obtaining a good position for the test, pressing on the area after the procedure, and by the 30 minutes you must remain in the unit at the end.

We have the facility for playing music, which some patients find relaxing whilst undergoing the procedure. Please feel free to bring your own favourite music for us to play for you.

Marker placement

Guidelines recommend that a marker clip is placed at the sample site at the end of the procedure. This is because so much of the area is likely to have been removed that it will no longer be visible on mammograms. If abnormal cells are found in the samples when they are looked at under the microscope, an operation may be required, and a marker is needed so that we can pinpoint the area for surgery. The marker is made of titanium and is sterile and harmless. It is the same as the marker you are likely to already have had placed after your original biopsy. It can be safely left in if no operation is required. It does not set off airport security cameras or metal detectors.

Will it hurt?

You are likely to find the procedure very similar to the x-ray guided biopsy you have already had.

Compression of the breast in the mammogram position may be a little uncomfortable, but this is usually not as bad as a standard mammogram as the degree of compression is less.

Your back/neck/shoulders may get a little stiff during/after the procedure.

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, please mention this to the Doctor. You may feel pressure in the area as the samples are being taken but it is not usually painful. If you do find it painful, please let the staff know and more local anaesthetic will be given.

Pressure will be applied to the sample site after the procedure, and this may be uncomfortable. However, this is very important to try and prevent bleeding/bruising. Very rarely, a surgeon may need to insert a superficial stitch to stop the bleeding.  

What are the advantages?

• No admission to hospital, which takes a whole day from 7am.

• No localisation to pinpoint the area required.

• No general anaesthetic required.

• Smaller incision/scar.

What are the risks?

There will be bruising after the procedure. The extent of bruising is unpredictable, but it is likely to be more than after your original biopsy as a larger amount of tissue will be taken. Sometimes, the bruising will affect the whole breast and may take several weeks to settle. Occasionally, bruising can be associated with a lump (haematoma), which can take months to settle. If large, a haematoma may require a small operation to remove it. Mild painkillers such as paracetamol may be required until the bruising has settled.

• There is a small risk of infection, which may be associated with redness or warmth at the site.

• Depending on the results, an operation may still be necessary.

• There is likely to only be a very small scar at the skin entry site of the vacuum needle. Please let the Doctor know if you have had problems with excessive scar build up (e.g., keloid) in the past.

If you notice excessive swelling, pain, redness, or bleeding, please call the Breast Care Nurses on 01752 431898, (this is an answerphone which is checked regularly Monday to Friday 8am to 5pm, so please leave your contact details and a nurse will phone you back) or contact your GP. Pressing on the wound firmly for 10 minutes will stop bleeding, in the unlikely event that it occurs.

Results

It usually takes up to 3-4 weeks for the results to become available. We will contact you to discuss the results when they are ready and outline any further procedures that may be necessary. 

We hope you have found this information sheet useful. If you have any concerns or require further information, please do not hesitate to get in touch via the Breast Care Nurses on 01752 431898.

It is helpful to know, prior to this procedure, if you are currently taking Aspirin or other tablets that thin the blood, such as Warfarin, Clopidogrel (Plavix) or Rivaroxaban (Xarelto).

 

Other formats

If you need this leaflet in another format such as Braille, large print, high contrast, British Sign Language or translated into another language, contact the Patient Advice and Liaison Service (PALS):

• 01752 439694

• plh-tr.PALS@nhs.net