Excisional biopsy, also known as an open surgical biopsy, is a surgical procedure to remove an area of abnormality in the breast. Unlike surgery for breast cancer, the procedure aims to remove only the area of abnormality without a rim of normal tissue.
Excisional biopsy is indicated when there is an abnormal area in the breast and fine needle or core biopsy is not possible or has given an inconclusive result. Occasionally, a patient may choose to have a benign lesion removed rather than continue surveillance.
What Is Involved in An Excisional Biopsy?
A guidewire may be required to localize an abnormal area in the breast that can be seen on imaging but cannot be felt clinically. The guidewire, a tiny wire similar to a fishing line, is inserted by a radiologist a few hours before the operation at the radiology practice. The abnormal area in the breast is identified with a mammogram or ultrasound. Local anesthetic is given and the wire is inserted under the guidance of the mammogram or ultrasound. Sometimes, more than one wire is required. After the wire has been inserted, a mammogram is often performed to check the position of the wire. The wire is then taped in place and you will be transferred to the operating theatre.
The operation is performed under general anesthesia. A small incision is made in the skin of the breast and the area of abnormality (along with the wire) is removed. An x-ray or ultrasound of the tissue is performed to confirm the abnormal area is within the removed tissue. The incision is infiltrated with local anesthetic and closed with dissolvable sutures and skin glue, and covered with a waterproof dressing.
The operation takes around 60 minutes.
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What Is the Expected Recovery After Excisional Biopsy Surgery?
. Hospital Stay. Most people go home on the day of surgery. It is recommended that you be accompanied home by a carer who will stay with you (or very close by) for the first 24 to 48 hours.
. Wound Care. Your wound is closed with dissolvable sutures and skin glue and covered with waterproof dressings. Remove your dressings in 2 weeks – your wounds should be healed by then and you do not need further dressings. You can massage your scar at 3 weeks using a plain moisturizer with firm circular motions for at least 10 minutes twice a day for 3 months.
. Bras. You may feel more comfortable wearing a supportive wire-free bra for the first few days.
. Driving. You should not drive for at least 24 hours after general anesthesia.
. Physical Activity. You are encouraged to do as much walking as is comfortable. Avoid lifting (over 1 kg), pushing or pulling for 2 weeks – this includes lifting children and housework such as vacuuming or hanging out the washing. Avoid exercises that create a lot of ‘breast bounce’ for 2 weeks – such as jogging or cardio sessions.
What Are the Risks of Excisional Biopsy Surgery?
All surgery has risks despite the highest standard of practice. Some of the possible risks associated with surgery for correction of inverted nipple include:
. Seroma: accumulation of fluid at the operation site which can result in swelling
. Unacceptable scarring, including hypertrophic or keloid scars
. Changes in nipple or breast sensation (temporary or permanent)
. Failure to remove the abnormal area: in about 2% of cases, the abnormal area is not found in the tissue removed during the operation and further surgery may be required
. Need for further surgery to treat complications