If you or your doctor have discovered a lump in your breast, you have probably been sent to get a mammogram, perhaps an ultrasound of your breast, and you have had an opinion from a surgeon about what to do next. Your surgeon may have told you that your lump is a cyst and will only want to watch this. Or you may have been told that you have a solid mass, and your surgeon may have recommended a breast biopsy.

A breast biopsy is a procedure that removes a small piece of tissue from the lump in your breast to see what the cells are. It is important to know prior to surgery if you have a cancerous (malignant) or non-cancerous (benign) tumor. Knowing what kind of tumor you have (a definitive diagnosis) will determine the best way to plan for treatment of the tumor.

The availability of advanced techniques and instruments has recently made it possible for many biopsies to be done in the surgeons’ office. It is vitally important that an adequate sampling of tissue is taken, and this can best be done with the most up-to-date instruments and techniques. If these were not available it would be necessary to have an open biopsy done in the operating room.

With an office-based biopsy there is no need for a large incision; there are no stitches placed, eliminating scarring. It is less costly, since there are no hospital charges involved. The surgeon’s and pathologist’s fees remain. Office procedures are more convenient to you. Local anesthesia is used, and the procedure will take less than 30 minutes. There is reduced discomfort and no need for a lengthy recovery period.

You will be awake throughout the procedure. No sedation is needed, only a local anesthetic to numb an area of the breast. The surgeon will then use ultrasound (high-frequency sound waves that locate and define the lump) to guide the biopsy instrument. He will then make a small nick (3-4 mm, less than the width of a pencil eraser) over the lump. The biopsy instrument will then be inserted and guided to the lesion (lump). The biopsy instrument then extracts a sample of tissue, which will be sent to a pathologist for definitive diagnosis. You will not require stitches, and only a small bandage will be used to cover the area.

Percutaneous (through the skin) breast biopsies are tolerated well, often allowing for continuation of normal daily activities right after the procedure. Mild analgesics are prescribed if needed. Patients rarely experience any significant discomfort during the procedure itself, as local anesthetic is used. This would feel similar to any injection you have received.

There may be a little soreness and swelling, but there should be no real discomfort and you can return to normal activities as you see fit.

Once your biopsy results are received from the pathologist, your surgeon will be able to plan the best treatment course for you.

If the biopsy is benign (not cancerous) a number of options are available, including doing nothing at all, excision to remove the lump or destruction (ablation or cryotherapy, destruction by freezing).

If the biopsy is malignant, further treatment is mandatory. A simple excision may be all that is needed. You may need chemotherapy or radiation therapy, and in some cases both. Various treatment options will depend on the particular type of cancer discovered, and will be discussed with you by your surgeon.

Darius S. Francescatti, M.D. is a leader in the development of new and convenient treatments for breast problems, and lectures widely to other surgeons on the surgical treatment of breast disease. He is one of only a few surgeons who is currently offering this advanced office technique.