Breast Biopsy: Purpose, Procedure, and What to Expect

March 6, 2025

A breast biopsy is a minimally invasive diagnostic procedure in which your surgeon cuts a small piece of tissue from the breast and sends it to the pathologist. The Pathologists examine it under a microscope to detect any pathology or malignancy in the breast tissues.

Why is Breast Biopsy Performed?

Breast cancer is the most prevalent disease in the world that most commonly affects females. It carries a high cost to society. In 2018, about 2.2 million people had breast cancer that was diagnosed by imaging techniques.¹ If you have abnormal findings on screening mammography or have a lump in your breast. Your surgeon will advise you to have a breast biopsy to check whether the lesion is malignant or not. A biopsy is the only confirmatory test to diagnose breast cancer. Biopsy rarely misses the breast and cancer.
A breast biopsy is indicated when you have abnormal findings on ultrasound, mammography, and MRI or when you have a lump in your breast. Other indications are:

Recurrent discharge from the nipple
Cyst formation just beneath the skin
Color changes in breast skin
Hard swelling in the breast

A doctor palpating a breast tumor

If biopsy shows malignancy or breast cancer, your doctor will plan treatment according to the stage of the tumor. People with early-stage breast cancer have a better prognosis than others.

Anatomy & Physiology of the Breast

Before getting into the details of breast biopsy, it is essential to know the detailed structure of the breast. Breast Biopsy is usually indicated in adults because the development of breasts remains dormant until puberty. It is unlikely to get breast tumors before the development of the breast.

Anatomy of the Breast:

The skin (dermis and epidermis) overlying the breast contains small blood vessels, nerves, lymphatics, sebaceous glands, sweat glands, and hair follicles. Following the dermis and epidermis, there is a hypodermis that contains larger blood vessels, fats, nerves, and lymphatics. The breast is separated from the other structures with the help of facial layers. The breast is attached to the fascial layer with the help of connective tissue known as suspensory ligaments or ligaments of Cooper. This ligament maintains the structural integrity of the breast. The strength of the ligaments weakens with age. Therefore, in old age, the breasts become loose and drooping.

The parenchyma of the breast contains multiple ductules that are lined by cuboidal epithelium and produce milk in response to the hormone. Ductules combine to form lobules. In lobules, ductules communicate with each other with the help of intralobular ducts. The intralobular duct then communicates with the extralobular duct. The lobules and extralobular duct combine to form the terminal ductal lobular unit. This is the primary site where malignancy can occur. Multiple terminal ductal lobes combine to create a lobe. There are about 10-20 lobes in a female breast. These lobes communicate with the nipple-areola complex. Before the communication, there is a small swelling called a sinus that stores the milk.²

Types of Breast Biopsy

There are multiple types of breast biopsy. The type of biopsy you need depends upon the size and location of the tumor. The kinds of breast biopsies include:

Fine Needle Biopsy:

It is the simplest form of biopsy in which your doctor takes a small portion of your breast tissue and sends it to the pathologist for further evaluation. He will use a skinny needle to take the biopsy of the affected part of the breast. Your doctor will advise it when the lump of the fluid is present just beneath the skin.

Fine-needle aspiration Cytology of the breast

Core Needle Biopsy:

It is a minimally invasive procedure in which a surgeon uses a hollow needle to take a sample of the breast. The procedure is typically performed under local anesthesia. The hollow needle is inserted into the breast, often guided by ultrasound, stereotactic (mammogram-based), or MRI imaging. This needle removes small tissue samples (cores) for pathological analysis to determine the nature of the abnormality.

Common imaging modalities used to locate and assess breast masses before or during biopsy include:.³

Mammography – Used to detect and characterize suspicious breast lesions.
Breast Ultrasound – Helps guide the needle in real-time, particularly for solid or cystic masses.
Magnetic Resonance Imaging (MRI) – Provides detailed imaging for further assessment, especially in dense breast tissue or high-risk patients.

Mammography before breast biopsy

Surgical Biopsy:

A surgical biopsy is an invasive procedure that a doctor advises when access from the other biopsies is difficult. There are two types of surgical biopsies (incisional biopsy and excisional biopsy). After injection of local anesthesia, your surgeon will incise the skin and remove the affected part of the breast.

Excisional Biopsy

It is the most common and invasive surgical procedure in which your doctor removes the whole tumor with surrounding normal tissue.

Incisional Biopsy

In this type of biopsy, your surgeon will remove only the affected part of the breast tumor. This procedure is rarely used nowadays.

Vacuum-Assisted Core Biopsy:

It is also a minimally invasive procedure, which involves giving a small incision on the breast. After that, your doctor will insert an imaging-guided hollow tube or needle (8G-11G needle) into it, and pull the affected part with the help of a vacuum.
The sampling error can be decreased by taking a large sample, as in the vacuum-assisted core biopsy.⁴

Sentinel Lymph Node Biopsy:

Sentinel lymph node biopsy is suitable for patients who are diagnosed with breast cancer. This biopsy helps in staging and the extent of the tumor. Doctors localize the sentinel lymph nodes preoperatively by injecting radioisotope-labeled albumin and blue dye into the breast. The recommended site for injecting dye is the subdermal plexus around the nipple, or near the axillary aspect of the cancer.⁵
If nodal disease is present, your doctor will recommend axillary clearance to avoid recurrence.

Stereotactic Breast Biopsy:

A stereotactic breast biopsy is a minimally invasive procedure that uses mammography to obtain a three-dimensional (3D) image of the breast. These images help pinpoint the exact location of a suspicious abnormality, guiding the biopsy needle to the affected site. The procedure is typically recommended for abnormalities seen on a mammogram that are not easily visible on ultrasound, such as microcalcifications or small masses.⁶

Contraindications of Breast Biopsy

The absolute contraindication of the image-guided breast biopsy is the non-visualization of the tumor. Other relative contraindications are :

Skin infection at the affected site
Abnormal clotting profile
Morbid obesity⁷
Metallic device in case of MRI

Preparation for a Breast Biopsy

Before getting into surgery, you have to go through a pre-surgical protocol that ensures your safety. Your doctor will advise you on some laboratory and imaging investigations that are important to evaluate before surgery. These investigations are the following:

Complete blood count (CBC) to check your anemia status. If your hemoglobin is low (7-8), your doctor may ask you to arrange 1-2 pints of blood.
White blood cell count (WBCs) helps your doctor see ongoing infections in your body.
Random blood sugar level to check your sugar status
C-reactive protein (CRP) to check for any acute infection
Clotting profile
Serology is advised if you have some discharge coming out from the nipple
Chest X-ray to check for any lung infection
Ultrasound breast
Mammography

Before the procedure, your doctor may ask some questions related to surgery: These are:

Do you have any allergies to some medicines?
Any bleeding disorder
Your medicine history
History of ischemic heart disease
Present pregnancy

After getting these results, your doctor checks if there is any serious abnormality that may affect the surgery or not. If the reports are normal, your doctor will send you to the anaesthesiologist to have your anesthesia fitness if open surgery is advised. After getting anesthesia fitness, your doctor will advise you not to eat 6-8 hours before surgery. He will ask you to remove your jewellery and other metallic stuff before entering the operating theater. He will mark an area to take a biopsy. Then you will enter the operation theater early in the morning.

A doctor performing an ultrasound of the axilla before biopsy

The Procedure of Breast Biopsy

The surgical biopsy can be performed in the outpatient department by applying local anesthesia, after which you can go home. However, some biopsies are taken under general anesthesia for which your doctor will advise you to stay at the hospital for further evaluation.

Needle biopsy:

In needle biopsy, the following steps are followed. These are:

Your doctor will describe the whole procedure.
Your doctor will take written consent from you to get permission from you for the procedure.
You have to sit or lie on the table, depending upon the type of procedure.
Your doctor will ask you to remove your clothes and wear a gown.
The area is sterilized by using pyodine.
He will inject local anesthesia at the operation site to numb the surgical area.
After that, he will pass a needle directly or by giving an incision at the concerned site.
He will take out a tissue or sample for biopsy and handover to you.
You have to submit it to the pathology lab for evaluation.
He will give you an ice pack that will help reduce inflammation and pain after the procedure.

Ultrasound-Guided Biopsy:

During an ultrasound-guided biopsy, the procedure is the same as above, but your doctor will use an ultrasound to locate the mass in your breast to take the biopsy.

Stereotactic Biopsy :

During this procedure, you have to lie on your chest with your breasts between the tables, and a computer gives a 3D image of your breasts.

Open Surgical Biopsy:

During the open surgery, your surgeon will give you general anesthesia, and take a biopsy. The procedure of open surgery is as follows:

Taking all septic measures, you will enter the operation theater. Your doctor will ask you to remove clothing and wear a gown
If your surgeon plans to give you local anesthesia, he will inject a local anesthetic agent into the affected area.
If he plans to give general anesthesia, he will inject anesthetic agent into the veins.
He will expose your chest and sterilize it with a sterile solution.
He will make a deep incision on your breast to expose the breast mass.
Then, he will excise a part of the breast mass and place it in a tray.
He will secure hemostasis (blood flow).
He will close the incision with the help of stitches.
Finally, he will apply a sterile dressing.
At the end, he will send the tissue to the lab for further evaluation.⁸

Markers of Breast Biopsy

A biopsy marker is a small seed-like stainless non-metallic material that your doctor places at the biopsy site after taking the biopsy to identify the biopsy area. The marker is too small to feel and doesn’t interfere with your radiology report. It does not cause any harm to your body and is safe. When your doctor advises surgery, he will remove the marker.⁹

Side Effects of Breast Biopsy

Breast biopsy is a safe procedure, but in some cases, some side effects occur. These are :

Bruising:

There can be a small bruise at the biopsy site. Bruising is expected after the biopsy and settles down without any intervention. However, in rare conditions, large bruises can occur that take weeks to heal. It most commonly develops after the core and vacuum-assisted biopsy.

Infection:

Using sterile and antiseptic needles has reduced the infection rate after breast biopsy. Therefore, infection after the biopsy is infrequent. If your breast becomes red and inflamed, tender, hot, and irritated. Consult with your doctor and book your appointment to address your issue.

Allergy:

Allergic reactions can occur due to local anesthetic, but are rare. Tell your doctor if you had a previous reaction due to local anesthetic.

Pain:

These procedures are pain-free because they are performed after local anesthesia that mimics your pain perception. However, you may feel some pain after the operation when the effect of anesthesia vanishes.

Hematoma Formation after Breast Biopsy

Hematoma is the collection of blood beneath the skin after the biopsy. Generally, hematoma resolves independently within 2-3 weeks without any intervention. But if they persist, your doctor will remove it surgically.

Pneumothorax:

It is a rare complication that can occur when there is damage to the lung covering during a biopsy that causes entry of external air into the lungs, resulting in pneumothorax. Clinically, pneumothorax is characterized by chest pain and shortness of breath. If you have these symptoms after the biopsy, immediately consult your doctor because it is a medical emergency.¹⁰

When will you get the results of the Breast Biopsy?

Your surgeon takes your biopsy and hands it to you or directly submits it to the pathology lab for further evaluation. Your pathologist takes 2-3 days to make a report of your biopsy. When you receive the report, you have to book an appointment with your doctor to see your biopsy report. Your doctor will discuss the treatment plan with you after the report.

A pathologist checking a breast biopsy sample

Recovery after Breast Biopsy

Recovery after the breast biopsy depends upon the type of procedure you had. If the biopsy was non-invasive (needle biopsy), you can recover in 24 hours after the biopsy. But if the breast biopsy is taken by open surgery (incision and excisional), then your recovery time may be delayed up to 2-3 weeks.

Conclusion

To conclude, breast biopsy is a minimally invasive procedure with a quick recovery time. There are several types of breast biopsy that your doctor can advise, depending on the location of the breast lump or tumor. If you feel any hard swelling, change in color, or nipple discharge, consult your doctor immediately for prompt diagnosis and treatment.

Refrences

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Derossis AM, Fey JV, Cody HS, Borgen PI. Obesity influences outcome of sentinel lymph node biopsy in early-stage breast cancer. J Am Coll Surg. 2003;197:896–901. doi: 10.1016/j.jamcollsurg.2003.08.005.
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Dahabreh, I. J., Lisa Susan Wieland, Adam, G. P., Halladay, C., Lau, J., & Trikalinos, T. A. (2014, September). Core Needle and Open Surgical Biopsy for Diagnosis of Breast Lesions. Nih.gov; Agency for Healthcare Research and Quality (US). https://www.ncbi.nlm.nih.gov/books/NBK246878/
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