Surgical (open) biopsy

Surgical (open) biopsy

Usually, breast cancer can be diagnosed using needle biopsy. Rarely, surgery is needed to
remove all or part of the lump for microscopic examination. This is referred to as a
surgical biopsy or an open biopsy. Most often, the surgeon removes the entire mass or
abnormal area as well as a surrounding margin of normal-appearing breast tissue. This is
called an excisional biopsy. If the mass is too large to be removed easily, only part of it
may be removed. This is called an incisional biopsy.
In rare cases, a surgical biopsy can be done in the doctor's office, but it is most often done
in the hospital's outpatient department under a local anesthesia (where you are awake, but
your breast is numbed), often with intravenous sedation (medicine given to make you
drowsy). This type of biopsy can also be done under general anesthesia (you are asleep).
If the breast change cannot be felt, a mammogram may be used to place a wire into the
correct area to guide the surgeon. This technique is called wire localization or
stereotactic wire localization. After the area is numbed with local anesthetic, a thin
hollow needle is placed in the breast, and x-ray views are used to guide the needle to the
suspicious area. Once the tip of the needle is in the right spot, a thin wire is inserted
through the center of the needle. A small hook at the end of the wire keeps it in place.
The hollow needle is then removed. The surgeon can then use the wire as a guide to the
abnormal area to be removed. The surgical specimen is sent to the lab to be looked at
under a microscope (see below).
A surgical biopsy is more involved than an FNA biopsy or a core needle biopsy. It
typically requires several stitches and may leave a scar. The larger the amount of tissue
removed, the more likely it is that you will notice a change in the shape of your breast
afterward.
Core needle biopsy is usually enough to make a diagnosis, but sometimes an open biopsy
may be needed depending on where the lesion is, or if a core biopsy is not conclusive.
All biopsies can cause bleeding and can lead to swelling. This can make it seem like the
breast lump is larger after the biopsy. This is generally nothing to worry about and the
bleeding and bruising resolve quickly in most cases.