What is an excision biopsy of a breast lump?

An excision biopsy of a breast lump involves removing a lump through a small cut.

What are the benefits?

An excision biopsy is usually performed for the following reasons:

• You may want to have the lump removed. You may have cosmetic reasons or the lump may be causing you pain.
• Your surgeon may be concerned about the lump. The tissue will be examined under a microscope to find out if you have cancer.

Are there any alternatives?

If the lump is probably benign and less than about 2 centimetres across, it may be possible to remove it using a special needle called a mammotome, but a mammotome excision is available only in a few specialist centres.

What will happen if I decide not to have the procedure or the procedure is delayed?

Your surgeon may not be able to confirm if you have cancer or recommend the best treatment for you. If your surgeon suspects the lump may be cancerous, the procedure will not be delayed.

If you are waiting for the procedure or have chosen not to have it and you experience any of the following symptoms, contact your healthcare team:

• the lump getting bigger or becoming noticeable to others
• new concerns about the lump
• new or worsening pain

If the lump is caused by cancer, early diagnosis and treatment will increase the chance of you being free of cancer.

What does the procedure involve?

If your surgeon cannot feel the lump, a breast radiologist will carry out a marking procedure using a mammogram machine or ultrasound scanner. This procedure will guide your surgeon to find out where the lump is.

The procedure is usually performed under a general anaesthetic but various anaesthetic techniques are possible. The procedure usually takes about 30 minutes.

If possible your surgeon will make the cut on the line of the areola (the darker area around your nipple).

Your surgeon will go through your breast tissue and remove the lump.

How can I prepare myself for the procedure?

If you smoke, stopping smoking now may reduce your risk of developing complications and will improve your long-term health.

Try to maintain a healthy weight. You have a higher risk of developing complications if you are overweight.

Regular exercise should help you prepare for the procedure, help you recover and improve your long-term health. Before you start exercising, ask the healthcare team or your GP for advice.

Speak to the healthcare team about any vaccinations you may need to reduce your risk of serious illness while you recover. When you come into hospital, practise hand washing and wear a face covering when asked.

What complications can happen?

The healthcare team are trained to reduce the risk of complications.

Possible complications of this procedure are shown below. Some can be serious and may even cause death.

Any risk rates given are taken from studies of people who have had this procedure. Your doctor may be able to tell you if the risk of a complication is higher or lower for you. Some risks are higher if you are older, obese, have other health problems or you smoke. Health problems include diabetes, heart disease or lung disease.

General complications of any procedure

• Bleeding during or after the procedure.
• Infection of the surgical wound.
• Allergic reaction to the equipment, materials or medication.
• Venous thromboembolism (VTE). This is a blood clot in your leg (deep-vein thrombosis – DVT) or one that has moved to your lung (pulmonary embolus).
• Chest infection. Your risk will be lower if you have stopped smoking and you are free of COVID-19. (coronavirus) symptoms for at least 7 weeks before the procedure.

Specific complications of this procedure

• Continued lumpiness under your wound. It is normal for your wound to feel lumpy and it usually settles within 4 to 6 weeks.
• Continued pain. You may not get relief from the pain.
• Dissatisfaction with breast appearance over time. Infection and bleeding can also affect the appearance of your breast.
• Change of nipple sensation. It usually settles but the change may be permanent.

Consequences of this procedure

• pain
• scarring of your skin, which can be unsightly

What happens after the procedure?

You should be able to go home the same day.

You should be able to return to work after 3 to 7 days.

You should be able to return to normal activities after about 10 days.

Regular exercise should help you to return to normal activities as soon as possible. Before you start exercising, ask the healthcare team or your GP for advice.

The healthcare team will arrange for you to come back to the clinic within 4 weeks. The lump that your surgeon removed will have been examined under a microscope. Your surgeon will tell you the results, check your wound, and discuss with you any treatment or follow-up care you need.

Summary

An excision biopsy involves removing a lump from your breast. It can help prevent an unsightly appearance and find out what is causing the lump. If the lump is causing you pain, you may get relief from the pain.

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