What is Open Surgical Biopsy?

Traditional open surgical biopsy is the gold standard to which other methods of breast biopsies are compared. Surgical biopsy requires a 1.5 to 2.0 inch incision (approximately 3.8 centimeters to 5.1 centimeters) in the breast. Until about a decade ago, most breast biopsies were open surgical procedures. However today, many patients are candidates for less invasive biopsy procedures such as vacuum-assisted biopsy (Mammotome or MIBB) or core needle biopsy.

How is Open Surgical Biopsy Performed?

First, the breast is cleaned and covered with special surgical drapes. Often, surgical biopsy does not require general anesthesia. Instead, the patient will be given a local anesthetic (to the breast only), or a combination of intravenous (through the vein) sedation with local anesthetic.

During an excisional surgical biopsy, the surgeon will attempt to completely remove the area of concern (lesion), often along with a surrounding margin of normal breast tissue. If the lesion is palpable (can be felt by examination), excisional biopsy is generally a brief, straightforward surgery performed in an operating room.

An incisional surgical biopsy is similar to an excisional biopsy except that the surgeon only removes part of the breast lesion. Incisional breast biopsy is usually only performed on large lesions.

In some cases, the surgeon will use mammography (x-rays) to help locate the area of concern and then mark the area with a wire marker, visible dye, carbon particles, or several of these methods. This technique is referred to as "needle" or "wire" localization and is necessary when the abnormality can only be seen on imaging tests, such as a mammogram or ultrasound, and cannot be felt by routine examination. With "needle" or "wire" localization, the radiologist will localize (identify) the abnormality seen on a mammogram or ultrasound using a thin, hollow needle. He or she will then insert a thin wire through the center of the hollow needle to indicate the exact area of removal. A hook at the end of the wire keeps it from slipping from the soft breast tissue. The radiologist will then remove the hollow needle, and the wire will be used as a guide to located the lesion (breast abnormality). A second mammogram is taken to make sure the wire is positioned in the correct area of the breast.

The woman is then taken to the operating room where the surgeon will remove the wire (which indicates the area of the breast abnormality) and a surrounding margin of breast tissue. One set of x-rays will be taken of the removed specimen with the wire. Another set of x-rays will be taken of the breast to confirm that the area in question has in fact been removed. When this is completed, the entire specimen will then be sent to the laboratory for examination by a pathologist.

The incision will be closed with suture material. If the suture material is absorbable, the stitches will usually dissolve on their own. However, if non-absorbable suture material is used, patients will need to have the stitches removed during a follow-up office visit.

How Should Patients Prepare for Open Surgical Biopsy?

Patients are typically given detailed instructions by their physician and anesthesiologist in advance of the day of their surgical biopsy. Patients should avoid eating or drinking anything after midnight if they are scheduled for a surgical biopsy the next morning or afternoon. There are exceptions when patients may be instructed to take certain regular medications, such as blood pressure medications or diabetes medication, by their physician or anesthesiologist.

Women should not wear talcum powder, deodorant, lotion, or perfume under their arms or on their breasts on the day of the biopsy (as these may cause image artifacts or other problems). Patients who take blood thinners or aspirin should ask their physician about discontinuing them prior to surgery (typically three days for coumadin or other blood thinners, seven days for aspirin or ibuprofen).

What Should Patients Expect After Open Surgical Biopsy?

Open surgical biopsy requires stitches and a longer period of recovery than percutaneous ("through the skin") breast biopsy procedures (such as fine needle aspiration (FNA), core needle biopsy, or vacuum-assisted biopsy). Usually, at least one full day of recovery is required.

The scar from a surgical biopsy is typically small. However, whether or not surgery will change the shape of a woman’s breast depends on a number of factors, including:

• The size of the breast lesion
• The location of the breast lesion
• The amount of surrounding breast tissue that is removed in addition to the lesion

What are the Advantages and Disadvantages to Open Surgical Biopsy?

Surgical biopsy yields the largest breast tissue sample of all the breast biopsy methods, and the accuracy of a diagnosis using the open surgical method is close to 100%, making it the "gold standard" of breast biopsy methods.

Nevertheless, while surgical biopsy may be the best choice for some patients, it does have disadvantages, especially if the breast lesion is found to be benign (non-cancerous):

• It requires stitches and can leave a scar
• Scar formation within the breast may persist for 12 months or longer and may complicate the interpretation of follow up mammograms

Other, more rare complications may include:

• Chances of bleeding, infection, or problems with wound healing
• Mortality risks associated with the use of anesthesia
• The chance of having a piece of the localizing wire break off deep within the breast (though this is not usually a serious problem even if it does occur)

Women are strongly encouraged to discuss all aspects of their biopsy with their surgeon prior to undergoing the procedure. Surgical biopsy usually requires at least one day of recuperation at home after surgery. Women should also discuss possible alternatives to surgical breast biopsy with their physician, such as vacuum-assisted biopsy and core needle biopsy.

Updated: August 29, 2007

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