While imaging can often confirm that a breast cyst is benign, the size of the cyst or symptoms from the cyst might necessitate additional evaluation by a breast surgeon. Many large breast cysts can be painful, and a simple needle aspiration in the office may relieve symptoms from the cyst. A cyst aspiration may be done with or without a local anesthetic, and often can be performed on the same office appointment. There may be a small bruise after the procedure, but nothing special needs done afterwards, other than avoiding heavy activity for 24 hours. Simple breast cysts can recur after aspiration, requiring ongoing follow-up.
Minimally invasive breast biopsy (MIBB):
MIBB is a breast biopsy that is done with a needle to obtain a diagnosis of a breast abnormality. There are three different types of MIBB, described below. MIBB is considered to be the quickest, safest, least invasive way to obtain a diagnosis for your breast abnormality, and is considered the standard of care for any new breast lesion.
Sometimes (for quicker scheduling, lesion location, or equipment availability), the physician might ask a breast-dedicated interventional radiologist to perform your procedure. In this case, be assured that Dr. Slam will interpret your pathology results, correlate them to your imaging to ensure accuracy, and formulate a plan. She will always remain in charge of your follow-up care, and should you have any questions, please call the office.
Risks of procedure:
As with every medical procedure, there are small risks. The biggest risks of MIBB are bruising, bleeding, wound infection, scarring, and chronic pain. There is also a small risk of non-diagnosis (not enough tissue for the pathologists to make a clear diagnosis) or false negatives (also known as mammographic-pathologic discordance). The risk of non-diagnosis and false-negatives are very low, but this is why follow up with me is so important, even after a benign biopsy. I will let you know if I am concerned about either of these possibilities after the procedure; I sometimes request additional biopsy if I am concerned about either of these.
Types of MIBB:
- Stereotactic Breast Biopsy: A type of MIBB that is done using a mammogram to guide the biopsy either of calcifications or a mass. This procedure is performed at an American College of Radiology (ACR)-Certified Women’s Health Center by either a Dr. Slam or a breast-dedicated interventional radiologist.
- Ultrasound (US)-guided Breast Biopsy: A type of MIBB that is done using an US to guide the biopsy of a cyst or a mass. This is performed typically at an ACR-Certified Women’s Health Center by a breast-specific interventional radiologist, or sometimes at the office, if feasible.
- MRI-guided Breast Biopsy: A type of MIBB that is only performed by MRI-specific interventional. This type of biopsy is typically done for a breast abnormality that is only visualized on MRI, and not on seen on either mammogram or US.
- FNA biopsy: Fine needle aspiration. This is typically reserved for cystic lesions and is usually done in office.
What to expect:
On the day of the procedure, you do not need to fast; with the exception of blood thinners and anti-platelet agents (for example, aspirin, Plavix, Coumadin, Pradaxa, and Xarelto), it is okay to take your regular medications. If you are on a medication that causes bleeding, make sure you have told me about this medication so it can be held prior to the procedure.
You will be checked in appropriately, and the typical length of visit (check in, procedure time, and check out) is about 1-1.5 hours, so plan accordingly. You may drive yourself home after the procedure, as this procedure is done with a local anesthetic. However, we always encourage someone to accompany you if available, in case you have just a little extra discomfort after the procedure.
Description of procedures:
Mammogram biopsies are performed on a “stereotactic table” at the Women’s Health Center. You will lie on your abdomen, and your breast will dangle through a hole in the table. The physician will then use several views of the mammogram to localize the area that needs biopsied. After this area is located, a local anesthetic will be placed at the area, which stings a bit. A small 2mm incision is then made at the site, and the needle is placed within your breast. Several more mammograms confirm good positioning of the needle, and then the biopsy is taken. This biopsy takes just a few minutes. Several cores of tissue are removed, and then sometimes an x-ray of the tissue is taken. Once the biopsy is complete, a clip is placed within the breast. The clip will stay within the breast to signify location of biopsy for future imaging follow-up. You will not set off alerts at the airport with this marker clip. After the clip is placed, the needle is removed and a light pressure will be held at the breast to stop any bleeding. A steri strip (butterfly bandage) is placed to close up the small needle hole.
For more information including a link to a video of the stereotactic biopsy procedure, please go to: www.mammotome.com/Stereotactic.aspx target.
Ultrasound and MRI biopsies are performed in similar manners. For an US biopsy, the technique is the same, but you will lie on your back instead of on your abdomen. An ultrasound probe is used to localize the area, and the technique is otherwise the same as described above. MRI guided biopsies are also performed with the patient positioned on their abdomen, and the technique is the same as with mammogram biopsies.
What to expect after the procedure:
Most people have a slight ache or tenderness within the breast for 48-72 hours afterwards, so strenuous activity (running, heavy lifting) should be avoided. If you have discomfort, it is okay to take Tylenol, Ibuprofen, or Aleve, and use ice packs as necessary. Some bruising is entirely normal, and a small number of women may develop a hematoma (collection of blood) within the breast after the procedure. If you develop a hematoma, it is not harmful, and with time, your body will reabsorb this blood slowly over a few weeks, just like a bruise.
Post-procedure instructions and follow-up:
It is ok to shower and get your incision wet in 24 hours, though swimming or baths should be avoided for 1-2 weeks. Just pat the area dry after showering. Pathology results are variable, and average 1-3 days, but do not worry if your pathology takes longer. Our pathology department maintains the highest quality standards, and this ensures an accurate diagnosis. In most cases, if your pathology is benign (non-cancerous), you will likely undergo repeat imaging in 6 months to serve as your new baseline exam. As always, you are entitled to your pathology report, so if we forget to offer it to you, please ask. Unless you request not to, we will also send your referring physician (and primary care doctor) your pathology results.