Key takeaways

  • A breast biopsy is the definitive method for diagnosing breast cancer. Doctors recommend biopsies when screening reveals potential signs of cancer, like lumps or nipple changes.
  • There are several types of breast biopsy procedures. These include fine-needle aspiration, core needle, and open biopsies. Each procedure varies in technique, needle size, and the amount of tissue removed for examination.
  • While a biopsy can cause temporary soreness, bruising, or swelling, the majority of breast biopsies yield benign results, and early diagnosis through biopsy allows for more effective treatment of cancerous cells

A doctor may recommend a biopsy if a person has an atypical mammogram result, a lump in the breast or nearby lymph node, or changes in the nipple, such as dimpling, thickening, scaling, or crusting of the skin.

The exact procedure and recovery expectations may differ depending on the type of biopsy a person has.

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A breast biopsy is the only way to definitively diagnose breast cancer. A healthcare professional may recommend it if they notice signs that could indicate cancer during routine breast cancer screening or if a person notices these signs at home.

The most common sign is a new lump or mass in the breast or chest. Other signs include:

Benign (noncancerous) health issues can cause the same symptoms as breast cancer. Not all biopsies will reveal breast cancer.

However, the outlook for breast cancer is more favorable if people have an early diagnosis and treatment. Therefore, a healthcare professional may suggest a biopsy to rule out cancer.

Below are some different types of breast biopsy:

Fine-needle aspiration biopsy

In a fine-needle aspiration biopsy (FNAB), the surgeon, pathologist, or radiologist uses a very thin needle and a syringe to withdraw, or aspirate, a few cells from a palpable lump. If a lump is palpable, it means that a person can feel it with their hand.

This procedure typically occurs if someone has a lump that could be a cyst, which is a benign sac filled with fluid.

An FNAB is a percutaneous procedure, which means the doctor passes a needle through the skin to reach the area for sampling. The needle is usually smaller than the type doctors use in blood tests. People do not usually need local anesthetic.

If the lump is easy to feel, a doctor can guide the needle to it by touch. If the lump is hard to feel, they may use an ultrasound to guide the needle to the right place.

Next, a laboratory analyst examines the fluid or cells under a microscope to determine if cancer cells are present.

Because doctors use such thin needles, there is the possibility of missing nearby cancerous cells. If the diagnosis is unclear, the doctor may recommend a different type of biopsy.

Core needle biopsy

In a core needle biopsy (CNB), the doctor removes small, solid tissue samples. The needle is hollow and slightly larger in diameter than an FNAB needle.

Two types of core needle biopsy include:

  • Spring-loaded: The needle is attached to a spring-loaded tool that quickly allows the needle to penetrate tissue.
  • Vacuum-assisted: The needle is attached to a suction device that pulls breast tissue into the needle.

The doctor may use an ultrasound or X-ray to guide the procedure. If a lump is palpable, they may guide the needle by touch.

The hollow needle withdraws cores, or small cylinders, of tissue from the mass. The needle may take 6 to 12 samples. The doctor may recommend a local anesthetic to numb the area.

A CNB takes longer than an FNAB, but it is less likely to miss cancerous cells, so the result is more reliable.

Open biopsy

Other names for this procedure include an excisional or surgical biopsy. These biopsies may aim to remove the entire area of an abnormality.

However, a healthcare professional may also perform an incisional biopsy, which only removes part of the target area.

A person usually undergoes this procedure in a hospital’s outpatient department, with either a local or general anesthetic, so that they feel no pain.

If the surgeon cannot find the lump by touch, they use X-rays to guide a thin, hollow needle to the mass.

They then thread a localization tool, such as a very thin wire with a hook at the end, into the hollow of the needle and attach it to the lump. This device guides the surgeon to the target area.

A surgical biopsy requires sutures, and there will be a scar. If the surgeon removes a significant amount of tissue, there may be a difference in the shape of the breast.

After removing the tissue samples, the doctor may leave a tiny clip or marker, made of surgical-grade material, to identify the biopsy site. This will be visible on a mammogram.

The marker points out the exact site of the biopsy so that a doctor can find it again easily if they need to.

This is especially important if a person has chemotherapy or another systemic treatment that change the size and shape of the mass. The mass may also disappear after treatment.

During surgery, the doctor may remove the clip and surrounding tissue, even if the mass is no longer visible.

People can speak with their healthcare team to understand exactly how to prepare for a breast biopsy.

A doctor will need to know what medications a person is taking. In many cases, people will continue taking medications as they usually do. However, people taking blood-thinning medications may need to stop temporarily.

A doctor will explain the type of biopsy a person is having and any necessary considerations. If a person will need anesthetic, they may need to avoid eating or drinking for a certain period before the biopsy.

A doctor may also advise that people not use deodorant, powder, lotion, cream, or perfume on their arms or breasts on the day of the biopsy. They may recommend bringing a cold pack to relieve any discomfort following the procedure.

People who undergo general anesthesia may go to a recovery room for observation after the procedure.

When their blood pressure, heart rate, and breathing are stable and they are mentally alert, they will be able to go home. They may still be a little drowsy, so they must usually arrange for someone else to drive them.

A person who has had local anesthesia can leave as soon as the recovery period is over.

Before leaving, it is a good idea to check next steps with the doctor, including how long results may take and how a person will get their results.

The exact recovery timeline and potential side effects a person experiences may depend on the type of biopsy they have.

After a biopsy, the area around any stitches must remain clean and dry. If there are no stitches, the medical team will give instructions about removing any necessary dressings or bandages.

The biopsy area may be sore and tender. People may also experience bruising, minor bleeding, or swelling, which can make the breast appear larger than usual.

Wearing loose clothing may help to minimize these symptoms. People should check with their doctor whether they are allowed to take pain relief.

A person’s healthcare team will explain exactly how to care for the biopsy site and the signs of complications that may require additional medical attention.

The doctor may recommend avoiding strenuous physical activity for a while.

A biopsy entails very few risks. Sometimes it can cause:

  • pain at the site or in the arm or neck
  • bleeding
  • bruising
  • swelling

Research suggests surgical biopsies may have a higher rate of complications than CNBs or FNABs. However, various factors can affect a person’s risk of complications.

Any type of biopsy carries a small chance of infection. If signs of infection occur, contact the doctor. These signs can include the appearance or worsening of:

  • fever or chills
  • redness or other skin color changes
  • bleeding
  • swelling
  • pain around the biopsy site

A biopsy does not always mean a person has breast cancer. In fact, 70% to 80% of breast biopsies have benign results.

If a biopsy shows cells that are positive for cancer, the person’s outlook may depend on the stage of their cancer. Diagnosing and treating cancer early, before it spreads, offers the most favorable outlook.

People can speak with their healthcare team to understand more about their outlook.

Types of breast biopsies include a fine-needle biopsy, core needle biopsy, and excisional or open surgery biopsies. The exact procedure, risks, and recovery timeline depend on the type of biopsy someone has.

A breast biopsy is the only way to definitively diagnose breast cancer. However, most breast biopsies have benign results, meaning a person does not have cancer.

People with an upcoming breast biopsy can speak with their healthcare team for more information on what to expect.