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Open Surgical Biopsy (Excisional and Incisional)

What is Open Surgical Biopsy?

Traditional open surgical biopsy is the gold standard to which other methods of breast biopsies are compared. Surgical biopsy requires a 1.5 to 2.0 inch incision (approximately 3.8 centimeters to 5.1 centimeters) in the breast. Until about a decade ago, most breast biopsies were open surgical procedures. However today, many patients are candidates for less invasive biopsy procedures such as vacuum-assisted biopsy (Mammotome or MIBB) or core needle biopsy.

How is Open Surgical Biopsy Performed?

First, the breast is cleaned and covered with special surgical drapes. Often, surgical biopsy does not require general anesthesia. Instead, the patient will be given a local anesthetic (to the breast only), or a combination of intravenous (through the vein) sedation with local anesthetic.

During an excisional surgical biopsy, the surgeon will attempt to completely remove the area of concern (lesion), often along with a surrounding margin of normal breast tissue. If the lesion is palpable (can be felt by examination), excisional biopsy is generally a brief, straightforward surgery performed in an operating room.

An incisional surgical biopsy is similar to an excisional biopsy except that the surgeon only removes part of the breast lesion. Incisional breast biopsy is usually only performed on large lesions.

In some cases, the surgeon will use mammography (x-rays) to help locate the area of concern and then mark the area with a wire marker, visible dye, carbon particles, or several of these methods. This technique is referred to as "needle" or "wire" localization and is necessary when the abnormality can only be seen on imaging tests, such as a mammogram or ultrasound, and cannot be felt by routine examination. With "needle" or "wire" localization, the radiologist will localize (identify) the abnormality seen on a mammogram or ultrasound using a thin, hollow needle. He or she will then insert a thin wire through the center of the hollow needle to indicate the exact area of removal. A hook at the end of the wire keeps it from slipping from the soft breast tissue. The radiologist will then remove the hollow needle, and the wire will be used as a guide to located the lesion (breast abnormality). A second mammogram is taken to ensure the wire is positioned in the correct area of the breast.

The woman is then taken to the operating room where the surgeon will remove the wire (which indicates the area of the breast abnormality) and a surrounding margin of breast tissue. One set of x-rays will be taken of the removed specimen with the wire. Another set of x-rays will be taken of the breast to confirm that the area in question has in fact been removed. When this is completed, the entire specimen will then be sent to the laboratory for examination by a pathologist.

The incision will be closed with suture material. If the suture material is absorbable, the stitches will usually dissolve on their own. However, if non-absorbable suture material is used, patients will need to have the stitches removed during a follow-up office visit.

Updated: August 29, 2007