What Is a Breast Biopsy?

Ease any pre-procedure anxiety with this practical guide on what to expect

Has your doctor recommended a breast biopsy? This procedure is the only diagnostic test that provides definitive results when determining whether a lump or other suspicious finding is cancerous. While a biopsy of the breast is usually minimally invasive and not very painful, it could seem scary if you don’t know what to expect—or if you assume it automatically means a cancer diagnosis, which isn’t the case.

Read on to learn what the procedure involves and what you and your doctor can learn from the results.

What is a breast biopsy­­?

A breast biopsy is a diagnostic procedure in which a small portion of breast tissue or fluid is removed and studied under a microscope to determine if cancer cells are present. Your doctor may order a biopsy if an imaging test, such as a mammogram, ultrasound, or MRI, shows a suspicious area in your breast, or if he or she feels a lump or thickening during a physical exam of your breasts. A biopsy may also be recommended if you’re experiencing breast symptoms such as crusted, dimpled breast skin, nipple discharge, and changes to the nipple or areola.

Keep in mind that a lump or other breast symptoms do not necessarily mean you have breast cancer. In most instances, the results will reveal benign conditions that can look or feel like breast cancer. These include fluid-filled cysts; benign breast tumors, such as adenomas; or thickening or firmness of the breast tissue (fibrosis), which is typically caused by changes in hormone levels.

What are the different kinds of breast biopsies?

You and your doctor will discuss which method is most appropriate for your unique situation. There are several factors to consider, including the size and location of the suspicious area, your doctor’s level of concern, and whether he or she can feel the lump. Other considerations include the state of your overall health, as well as your personal preference.

Here are the main types of breast biopsy procedures:

Fine needle aspiration: During fine needle aspiration (FNA), the doctor removes suspicious fluid or tissue from the breast using a thin, hollow needle. FNA is typically performed when the lump is thought to be a fluid-filled cyst or when it’s unclear on imaging whether the area is a small cyst or solid mass. It’s often used when the doctor can feel the lump, which allows him or her to guide the needle to the correct location by touch. If the doctor can’t feel the area easily, he or she may perform an ultrasound-guided FNA. This procedure allows the doctor to see images of the inside of the breast to help guide the needle to the right location.

Core needle biopsy: A core needle biopsy (CNB) is typically performed when breast cancer is suspected based on a physical exam or results from screening, such as mammography. CNB is preferred in this situation because the hollow needle is larger than the one used in FNA, so a greater amount of tissue can be collected. The needle may be attached to a tool that moves the tissue in and out of the breast quickly or to a device that helps suction the breast tissue into the needle (vacuum-assisted core biopsy).

If your doctor is unable to guide the needle into the suspicious tissue by feel, he or she may use imaging during your CNB to help locate the correct area to be biopsied. Imaging techniques include mammogram (stereotactic biopsy), MRI (MRI-guided core needle biopsy), or ultrasound (ultrasound-guided core needle biopsy). When the correct area is located, your doctor will likely identify it with a very small tissue marker, or clip. You won’t be able to see or feel it, but it will appear on imaging tests, enabling your doctor to find the area again should you need future treatment or follow-up.

Surgical (open) biopsy: Rarely,doctors need to obtain a breast tissue sample surgically. This may be the case if the results of a needle biopsy are unclear or the suspicious area is too large to sample with a needle. There are two types of surgical biopsies: an incisional biopsy, in which part of the suspicious area is taken out, and an excisional biopsy, in which the whole lump—and possibly an edge (margin) of normal tissue surrounding the lump—is removed. These breast biopsy procedures may also include imaging prior to surgery (mammogram, MRI, or ultrasound) if the suspicious area cannot be easily felt. This step, called preoperative localization, allows the surgeon to insert a wire (wire localization) or other localization method (radioactive seeds or radiofrequency reflectors, both of which are very safe) into the area to be removed to help guide the needle.

Skin punch biopsy: If you have a rash or area of redness on your breast skin, you may need a skin punch biopsy, which can rule out inflammatory breast cancer (IBC), a rare and aggressive form of the disease. (In addition to a rash or redness, IBC can cause other visible symptoms such as swelling, pitting or thickening of the breast skin, and a retracted or inverted nipple.) In a skin punch biopsy, the doctor uses a cutting tool to remove a sample of tissue from deep within the skin.

What can I expect during a breast biopsy?

FNA and CNB are somewhat similar experiences. Both are outpatient procedures that are usually performed in a doctor’s office. Your doctor may inject a numbing medicine (local anesthesia) prior to FNA to keep you comfortable, but it’s not always needed. (The needle used in FNA is so thin—thinner than the one used to inject the anesthesia—that numbing the area could be more uncomfortable than the procedure itself). Local anesthesia is always provided for a CNB, as the needle is larger; plus, your doctor may need to make a small incision on your skin where the needle is inserted.

Pain during FNA and CNB is usually mild, though you may experience more discomfort if you have dense breasts or abnormalities behind the nipple. You will likely feel pressure when the needle is inserted into the breast, but this is normal.

A surgical biopsy of the breast is almost always performed in a hospital or surgical center. You’ll be sedated prior to the procedure with either a combination of local and intravenous anesthesia (conscious sedation, also known as twilight sleep) or general anesthesia, which puts you into a state similar to deep sleep. The surgeon makes an incision and removes all or part of the suspicious area, then closes the incision with stitches. You can usually go home the same day.

A skin punch biopsy is an in-office procedure. After injecting a local anesthetic into the breast, your doctor inserts a round, cookie cutter-like tool into the breast skin tissue and rotates it to cut out a very small cylinder-shaped sample. Your doctor may remove it with surgical scissors or a needle, and then you’ll get just a stitch or two to close the wound.

How long does a breast biopsy take?

FNA usually takes about 10 to 15 minutes or, if you’re getting ultrasound-assisted FNA, 20 to 30 minutes. A CNB usually requires 15 to 20 minutes, but it may take up to an hour if your doctor uses imaging to guide the needle. Surgical biopsies take two hours or more, including recovery time. A skin punch biopsy can be completed in about 15 minutes.

What is the breast biopsy recovery process like?

If you’re getting FNA, there is virtually no recovery time. You may notice some temporary swelling, bruising, or pain at the injection site. FNA usually leaves no scar.

Recovery from a CNB is also brief. As with FNA, you may experience some temporary swelling and bruising afterward. In most cases, this procedure does not cause scarring.

It takes more time to recover from a surgical biopsy. You’ll likely feel pain and fatigue for the first few days after surgery, and you might need to take a day or two off from work. Your doctor may instruct you to avoid strenuous activities (jogging, physically challenging housework, etc.) and lifting heavy objects for two weeks following the procedure. A surgical breast biopsy may leave a scar and/or, depending on the amount of tissue removed, a change in the shape of your breast.

With a skin punch biopsy, you can expect the wound to heal in seven to 10 days. You may notice swelling, redness, or bruising on or around the biopsy area, but these go away in a few days. The area may look a bit pink and raised for a few months after that, but this will eventually fade.

Aftercare is similar for all types of breast biopsies. Your doctor or nurse will provide you with instructions on how to care for the wound (how often to clean it, reapply dressings, etc.) and whether any stitches will need to be removed, or if they’ll dissolve on their own. You can relieve uncomfortable post-procedure symptoms such as bruising and swelling by applying ice packs to the breast, wearing a supportive bra, and taking acetaminophen. Avoid nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil, Motrin) and naproxen (Aleve), which can cause bleeding.

Complications from a breast biopsy procedure are very rare, but there is some risk of infection. Call your doctor right away if you develop symptoms such as pus, persistent redness, or a fever.

What percentage of breast biopsies are cancer​?

Of the estimated 1.6 million breast biopsies performed in the U.S. annually, 75 percent of the results are benign (noncancerous). If your breast biopsy is one of the 25 percent of results that indicate cancer, know that treatment options are available and when breast cancer is caught early, it has a good outcome.