Finding a lump in your breast can be terrifying, but that fear shouldn’t stop you from getting it checked out by your doctor. If your doctor doesn’t immediately know what’s going on and wants to dig a little deeper, or if they’re concerned it may be breast cancer, they’ll likely order a breast biopsy.
A breast biopsy is designed to help you get concrete answers when something like a physical exam, mammogram, ultrasound, or MRI has indicated you have a breast lump worth investigating, John Kiluk, M.D., associate member of the Breast Oncology Department at Moffitt, tells SELF.
Getting a biopsy doesn’t automatically mean that your lump is cancerous, or even that it’s likely to be. In fact, most breast biopsies don’t show any evidence of cancer, according to the American Cancer Society (ACS). But it’s still scary to think about that prospect and undergo the procedure, especially if you feel like you’re in the dark. In an effort to take some fear out of the process, we consulted with experts to explain exactly what you need to know about getting a breast biopsy.
1. There are actually several types of breast biopsies. The kind you get depends on a lot of factors, like how big a sample your doctor wants.
A breast biopsy involves removing fluid or tissue from a suspicious area in your breast, the ACS explains. A doctor who specializes in analyzing these samples (a pathologist) then examines your cells under a microscope to check for breast cancer.
Here’s a rundown of the different types of breast biopsies that may be available to you:
- Fine-needle aspiration biopsy: This is the simplest type of breast biopsy, and it’s typically done when a doctor can feel the lump in question so they can guide the needle into the right place, according to the ACS. However, a doctor might decide to use an ultrasound (high-frequency sound waves) to help locate the lump.
To get this kind of biopsy, you’ll lie down on an exam table, your doctor will steady the lump with one hand, then they’ll use the other to put a very thin needle into the lump, the Mayo Clinic explains. That needle is connected to a syringe that can collect fluid or cell samples from the lump. If the doctor can pull some fluid from the lump, that can hint at a fluid-filled cyst rather than a tumor (it’ll still need to get tested for confirmation, though). But if it’s a solid mass, they’ll get tissue instead and send that to the pathologist.
- Core needle biopsy: This is usually used to assess a lump that your doctor can see via imaging tests or feel during a breast exam, the Mayo Clinic says. A doctor will use a needle to remove tissue samples from the lump using some sort of imaging as a guide.
A core needle biopsy will take a larger tissue sample from the area than a fine-needle aspiration biopsy, Elsa M. Arribas, M.D., associate professor of breast imaging at The University of Texas MD Anderson Cancer Center, tells SELF. “We usually decide between a fine-needle aspiration and a [core needle] biopsy based on how much tissue we think the pathologist will need based on what we think the lesion will be,” Dr. Arribas says. “We want to make sure that the lesion gets sampled thoroughly to be able to get an answer for the patient without delays.”
There are a few different types of core needle biopsies:
- Ultrasound-guided core needle biopsy: As you can probably guess, this relies on an ultrasound to pinpoint exactly where the lump is. You’ll lie on your back or side on a table so the doctor can hold the ultrasound device against your breast, find the mass, insert a needle, and take samples.
- MRI-guided core needle biopsy: This uses a machine that takes multiple cross-sectional images of your breast then combines them to create 3D pictures. To get these photos, you’ll need to lie down on a padded scanning table that has a slight dip for your breasts to fit into. After the doctor has located the mass, they can go ahead and insert the needle for sampling.
Vacuum-assisted core biopsy: For this kind of biopsy, your doctor will use a hollow probe to remove tissue for testing, the ACS says. They’ll insert the probe through a small cut in your breast, get it into place with the help of an imaging machine, then suction a sample of tissue into the device. This typically removes more tissue than a core biopsy with a needle, according to the ACS.
Sterotactic biopsy: This type of biopsy, which can be done with a needle or a vacuum-powered probe, uses mammogram imaging to find the location of the lump in your breast before a doctor makes a small incision to remove some samples. Most likely, you’ll lie facedown on a padded table with one of your breasts positioned in a hole in the table, or you might be seated for the whole thing, the Mayo Clinic says.
The procedure itself involves two plates compressing your breast while the machine takes images to help show the doctor exactly where the lump is. Then the doctor makes an incision about ¼ inch long into your breast and inserts a needle or vacuum-powered probe to remove several samples of tissue.
- Surgical biopsy: This form of biopsy involves removing either a portion of your mass (this is called an incisional biopsy) or the entire thing (known as excisional biopsy, wide local excision, or lumpectomy), according to the Mayo Clinic.
If a doctor can’t feel your breast mass physically before surgical excision, they might try to locate it with a tactic called wire localization, which places the tip of a thin wire in or through the mass. Then your doctor will remove the entire mass, plus the wire. Doctors will test the mass for cancer, and if they find any, try to determine whether or not they got all of it. If they removed the entire cancerous mass (they can tell by testing the edges of the tissue for cancer cells), this could be the only surgery you need. If you still have cancer cells at those margins, you may need to consider more.
2. Your doctor might also want to biopsy your lymph nodes to check them for cancer.
In a lymph node biopsy, your doctor will take samples from the lymph nodes under your arm. These nodes have immune cells to filter out harmful substances from your body’s lymph fluid, which carries oxygen and nutrients to your cells and also carries waste products away from them, according to the ACS. When breast cancer spreads, it usually goes to those nearby lymph nodes first.
Your doctor can perform a lymph node biopsy with a needle or after removing the nodes via surgery, according to the ACS. Depending on which option makes the most sense for you, this can happen at the same time as your breast biopsy, or, if you’re having a mass excised surgically, it can happen during that procedure.
3. The level of discomfort you experience depends on the type of biopsy, but no matter which you get, it shouldn’t be enormously painful.
Having anything inserted into your breast sounds like a world of hurt, but most incisions and needle biopsies are done only after you get a local anesthetic, Dennis Holmes, M.D., a breast cancer surgeon and researcher and interim director of the Margie Petersen Breast Center at John Wayne Cancer Institute at Providence Saint John’s Health Center in Santa Monica, California, tells SELF. (Fine-needle aspiration biopsies are sometimes an exception, since the needle is so thin that getting the anesthetic might hurt more than the actual procedure, the ACS notes.) The process of injecting the anesthetic can cause a burning sensation that usually lasts just a few seconds until the medication takes effect, he says. After that, you may feel pressure during the biopsy, but it shouldn’t be sharp and painful like you might imagine, Dr. Arribas says.
Anyone who’s gotten a mammogram knows they’re not exactly a delight, and that also applies to any biopsies involving one. “The compression is light, but it can become uncomfortable with time,” Dr. Arribas says.
When it comes to a surgical biopsy, a doctor will typically perform the procedure in an operating room, and you may have a combination of IV sedation and a local anesthetic for your breast, the Mayo Clinic says.
4. You might feel some discomfort after the biopsy, in which case painkillers and an ice pack may help.
Immediately after your biopsy, you’ll still mostly be numb but may feel a little sore and swollen, R. Jared Weinfurtner, M.D., a breast imaging radiologist at Moffitt Cancer Center, tells SELF. This may increase over the next few hours as the numbing medication wears off. One thing you can do is take a painkiller (without aspirin so you don’t accidentally thin your blood—more on that in a bit).
Using a cold pack can also help reduce your pain and risk of bruising afterward, Dr. Holmes says. Bruising happens if your blood vessels break and leak blood underneath your skin. Cold temperatures cause vasoconstriction, which is when your blood vessels narrow and close faster than they otherwise would. This is why applying a cold pack right after an injury is one of the few methods of trying to ward off a bruise that can actually work.
The thing about a cold pack is that it can only do its job when it’s actually next to your breast. Wear a bra or take one with you to your appointment so it can hold the pack after your procedure, the Mayo Clinic says. If you’d like a cold pack and your provider doesn’t offer you one, feel free to ask.
5. You should avoid taking aspirin or other blood thinners before your biopsy because it can make you more likely to bruise.
It’s important not to have any aspirin for seven days before your procedure, and you should let your doctor know if you’re on blood-thinning medications, the Mayo Clinic says.
Blood-thinning medications (which include aspirin) can increase the amount of time it takes for your blood to clot, Dr. Weinfurtner says. This increases your risk for a large hematoma (a collection of clotted or partially clotted blood) after the procedure, Dr. Weinfurtner says, explaining that this can create bruising and discomfort that last for weeks.
If you’re on a blood thinner, ask your doctor in advance if it’s worth it for you to temporarily go off of it. In some cases, a doctor may feel that the risk is too high, Dr. Weinfurtner says.
6. You may be able to get back to your normal activities within a day of your biopsy, but you should ask your doctor just to be sure.
The amount of time your biopsy takes will vary based on which kind you have. For example, a fine-needle aspiration biopsy should take 20 to 30 minutes maximum, according to the ACS, while an excisional breast biopsy can last around an hour.
Expect to go home the same day of the procedure, no matter which kind you get. Once you’re there, it’s important to rest for the remainder of the day, the Mayo Clinic says. After that, you can typically get back to your normal activities within a day, but you should ask your doctor if you have any specific questions about when you can return to certain activities. Doctors often recommend that, for a few days, you don’t do any heavy lifting or repetitive motions (like sweeping or playing tennis) on the side where you had the biopsy, Dr. Kiluk says. This can depend on your specific situation, so double-check if you’re concerned.
A surgical biopsy is typically the only kind that will require stitches. If you do need them, your medical team should explain exactly how to care for them so you can avoid infection.
7. In some cases, the appearance of your breast might change, especially after a more invasive biopsy.
This isn’t common, but if your doctor needs to remove a lot of tissue for your biopsy (like with a surgical biopsy), there’s a chance that your breast could look different afterward, the Mayo Clinic says. A surgical biopsy is also the kind most likely to leave behind some sort of noticeable scar, though there’s a possibility you could wind up with a tiny permanent mark with the other forms if you’re prone to scarring, Dr. Weinfurtner says. Ultimately, if you’re worried about this, talk to your doctor to determine how likely it is to happen to you.
8. You can typically get your results within a week so that you can move forward with next steps.
Every medical center is different, but most can deliver your results between three to five business days, Dr. Weinfurtner says. Ask your doctor when you can expect your results. After that, the two of you can discuss where to go from there, whether that involves a different kind of biopsy if the results weren’t clear, treatment options if you do actually have a form of breast cancer, or simply scheduling your next mammogram or follow-up visit if your doctor confirms you have nothing to worry about.
Although it can be useful to have this kind of information before you get a breast biopsy, you might still have questions or fears about the procedure. Don’t be afraid to bring them up with your doctor. That’s what they’re there for, after all.