Breast Biopsy and Cancer: What Results Do and Don’t Mean

If you have a mammogram that yields concerning results, your healthcare provider may recommend a breast biopsy. It can be worrying to know you need further testing, but keep in mind that only 20% of breast biopsies come back positive for breast cancer. Getting a biopsy is important because it ensures timely treatment if malignancy is found. 

Of the several types of breast biopsies, the most common ones are fine needle aspiration, core needle biopsy, and surgical (open) biopsy Multiple factors, such as the size, appearance, and location of the suspicious mass, will determine the type of biopsy you need.

This article will describe breast biopsy techniques. It will also provide information on what to expect before, during, and after the procedure, including how to prepare, the pain or discomfort you may feel, and interpreting results.

An illustration with 3 types of breast biopsies

Illustration by Ellen Lindner for Verywell Health

Why Did My Provider Order a Breast Biopsy?

Breast biopsies are used to definitively make a diagnosis of breast cancer. Along with imaging tests and a physical exam, they can also be used to stage the cancer (determine how advanced it is).  

Your healthcare provider may order this test for you if an imaging test, such as a mammogram, ultrasound (sonogram), or breast magnetic resonance imaging (MRI), shows potential signs of breast cancer.

Your healthcare provider may also order this test for you if you have breast symptoms or changes that might indicate cancer, such as:

  • A hard or soft lump that can be felt
  • Swelling in all or part of the breast
  • Dimpled or puckered skin that resembles an orange peel
  • Pain in any area of the breast, including the nipple
  • A nipple that becomes inverted (turns inward)
  • Skin changes in the breast or nipple, including redness, flaking, thickening, or dryness
  • Nipple discharge that is bloody or not associated with lactation (breast milk production)
  • Swelling under an armpit or around the collarbone, where lymph nodes are located
  • A feeling of warmth or heaviness in the breast

Techniques Used to Get a Breast Biopsy

During a breast biopsy, fluid or small breast tissue samples are removed and analyzed in a lab for cancer cells. You will know the type of biopsy you're having ahead of time, so you can prepare appropriately. In some instances, your healthcare provider may also do a lymph node biopsy at the same time as your breast biopsy.

Fine Needle Aspiration

Fine needle aspiration is a non-surgical, outpatient procedure done with a thin, hollow needle attached to a syringe. The needle is used to extract fluid or breast tissue from the suspicious area.

This procedure is often used to extract fluid from a painful breast cyst. If a breast mass is difficult to feel by hand, your provider may use ultrasound to guide the needle.

The needle used for this procedure is very thin, so numbing is not always needed. Topical numbing (applied to the skin) with an agent like lidocaine is usually enough to reduce or eliminate discomfort. Ask your healthcare provider if and how they plan to numb the area so you know what to expect.

General anesthesia is not needed for fine needle aspiration. During this procedure, you will be awake and in a supine position (lying face up). The procedure takes around 20 to 30 minutes.

Core Needle Biopsy

Core needle biopsies are non-surgical, outpatient procedures done with a local anesthetic. This is the type of biopsy most commonly used when breast cancer is suspected.

Your provider will insert a very thin needle containing anesthetic into the area to be biopsied. A small cut may then be made in the breast tissue. A thin, hollow needle will be inserted to extract cylinder-shaped breast tissue samples from one or more locations.

The needle will be attached to a spring-loaded tool or a suction device. It will be guided into the mass with the help of an imaging tool, such as an ultrasound, breast MRI, or mammogram.

Mammogram-guided biopsies are called stereotactic biopsies. If you have this type of biopsy, your breast will be compressed in a mammography machine for imaging before the procedure.

Since general anesthesia is not used, you will be awake during the test. Core needle biopsies are relatively quick but typically take longer than fine needle aspirations.

Surgical (Open) Breast Biopsy

Surgical biopsies are outpatient procedures typically done in hospitals. Surgery is not commonly used to biopsy the breast. However, your provider may recommend having a surgical biopsy if a needle biopsy produces unclear results.

During a surgical biopsy, all or part of the suspicious area will be cut and removed with a scalpel and other tools. The excised tissue will be checked under a microscope in a laboratory for cancer cells.

A margin of normal breast tissue will also be removed for laboratory analysis. This helps indicate if cancer has spread, should a malignancy be found.

If your surgeon cannot feel or locate the suspicious mass, a localizing device may be placed into the area before the biopsy. This part of the procedure is referred to as preoperative localization.

Imaging tests will help your surgeon place the localizing device, such as a wire or radioactive seed, into the area to be biopsied. Preoperative localization may be done right before the biopsy or earlier.

Before the biopsy, a local anesthetic will be injected into your breast, and you will be given intravenous (IV) sedation that makes you very drowsy. In some instances, general anesthesia that puts you into a deep sleep will be used instead. Both options protect you from feeling pain during the biopsy.

Skin Punch Biopsy

This less-common procedure is done if inflammatory breast cancer (IBC) is suspected. Only around 3% of all breast cancers are of this type.

For a skin punch biopsy, a small sample of breast skin, plus tissue under the skin, will be extracted with a hollow, round-tipped scalpel.

This outpatient procedure usually takes around 15 minutes and is typically done in a healthcare provider's office or ambulatory care setting. A local anesthetic will be applied to the skin to freeze it prior to the procedure. In some instances, one or two stitches will be needed to close the surgical wound.

How Long Do Breast Biopsies Take?

The type of biopsy you have will determine how long the procedure will last. In general, you can expect these timeframes:

  • Punch biopsies take around 15 minutes.
  • Fine needle biopsies take 20 to 30 minutes.
  • Core needle biopsies may take up to an hour or longer, especially if imaging is used to guide the needle.
  • Surgical biopsies can take two hours or longer, including recovery time.

Pain-Wise, How Does a Breast Biopsy Feel?

You should feel little to no pain during any biopsy procedure. During needle biopsies, you may feel discomfort or pressure when the needle enters your skin. If imaging wands are used directly on your breast, you may also feel pressure from the wand.

If you're having a surgical breast biopsy, you will either be sedated or in a deep sleep. Either way, you should not feel pain during the procedure.

Will I Get a Scar From a Breast Biopsy?

The type of biopsy you have will determine whether you're left with a scar. In general:

  • Fine needle aspiration biopsies heal without scarring.
  • Core needle biopsies sometimes cause small scars to form.
  • Surgical breast biopsies can cause scarring.
  • Punch biopsies cause little to no scarring.

Day of Your Breast Biopsy

Your healthcare provider's office will provide instructions and prepare you beforehand. Make sure to let them know about allergies and medications and supplements you currently take. If you're having a surgical biopsy, you may be instructed ahead of time to stop taking certain drugs, such as those that inhibit blood clotting (coagulation).

The type of procedure you're scheduled for will determine the protocol you follow and your after-instructions.

Before

If you're having a surgical biopsy, you will be instructed to stop eating and drinking for a specified number of hours prior to the procedure. Needle and punch biopsies do not require fasting.

If you have not already done so, you will be given a consent form to fill out upon your arrival. Make sure to read it thoroughly and ask any questions you have.

If you're having a surgical biopsy, you will most likely meet the anesthesiologist prior to the procedure. Ask them any questions or concerns about the type of sedation you will be given.

Don't use products like deodorant, powder, or lotion on your arm, underarms, breasts, or chest on the day of the procedure. Consumer goods like these sometimes contain aluminum and other minerals, which mimic the appearance of calcifications on imaging screens.

You will be given a hospital gown to put on. Wear comfortable clothing to change back into after your biopsy. Ask your healthcare provider if you should wear a stretchy bra big enough to accommodate a bandage. In some instances, your bra may be used to hold an ice pack in place during recovery or afterward.

During

If you're not having a surgical biopsy, you will be awake during the procedure. Most biopsies take under an hour to complete from start to finish.

If imaging guidance is done, your body will be positioned to accommodate the type being used. You may be seated or positioned lying face up or face down on a raised table with openings for your breasts.

A numbing agent will be used on your skin before any needle insertion or cut is made. Your comfort level will be monitored throughout the entire procedure. You must remain still during the biopsy. If you're uncomfortable or need to move, let your provider know immediately.

After extracting the tissue, a tissue marker (clip) may be placed in the affected area. This identifies the exact spot where the biopsy was done in case additional treatment is needed. You won't feel the clip, but it will be visible on subsequent imaging tests.

When the biopsy is complete, pressure will be applied to stop any bleeding. If you had a surgical biopsy, your surgeon will stitch the surgical wound closed. Needle biopsies don't usually require stitches. A sterile bandage will be placed over the area.

After

After the biopsy, you will rest for a period of time in a recovery area. If you had general anesthesia or sedation, you must not drive and will need to have someone pick you up and take you home.

Temporary bruising, bleeding, and swelling are common after-effects. Don't be concerned if your entire breast, or the excised area, seems larger than usual. This is caused by swelling and is to be expected. You may also feel some discomfort for a day or two in the breast or at the needle insertion site.

If your pain increases significantly, you run a fever, or the wound leaks pus, inform your provider immediately. These symptoms may indicate infection.

Your provider will let you know when you can expect your biopsy results. This can take several days or up to a week.

Self-Care After a Breast Biopsy

Follow these at-home tips after the procedure:

  • Leave your bandage on for a full day. You can shower once it is removed.
  • If surgical paper tape was placed on the excised area, leave it on for three days or until it falls off. Don't remove the tape to bathe.
  • Alleviate swelling and bruising by applying an ice pack for 10 to 15 minutes several times a day for one or two days.
  • Take over-the-counter pain medication if needed.
  • Stop any bleeding by applying pressure to the excised area. Bleeding that doesn't stop should be brought to your healthcare provider's attention.
  • Wearing a snug bra may make the area feel supported and secure.
  • Don't do any heavy lifting or strenuous exercise until healing is complete.

Normal Breast Biopsy Results

If your pathology report returns with a normal or negative result, no cancer cells were found in the excised tissue or fluid.

Even with normal results, you may need additional testing in some instances:

  • Fine needle aspirations sometimes miss cancer cells. Additional testing may be warranted if you or your healthcare provider have ongoing concerns.
  • Core needle biopsies typically excise enough tissue to identify any existing cancer. If not enough tissue is removed for extensive testing, this procedure may miss cancer cells. Surgical testing may be recommended if the biopsy results don't provide a clear diagnosis.

Benign Breast Biopsy Results 

A benign biopsy also indicates that no cancer cells were found. If you get a benign result instead of a negative or normal result, the pathologist (specialist in lab and anatomic medicine) identified a finding of note that is not cancer. These include non-malignant (not cancerous) calcifications or masses.

Positive Breast Biopsy Results 

Positive breast biopsy results mean that cancer cells were found. If you get a positive result, the pathologist's report may also include information to support your treatment plan, such as:

Follow-Up to Make a Treatment Plan

If you get a breast cancer diagnosis, additional testing will be needed to determine the kind of cancer you have, its aggressiveness, and its stage. The goal of these tests is to create a successful and effective treatment plan.

This may include a variety of strategies for you to consider, including lumpectomy versus mastectomy, chemotherapy, and radiation. You may also want to talk to your surgeon about breast reconstruction options.

This can be an overwhelming and scary time. Even though you'll want to move quickly, give yourself time to digest the information you're receiving. Get a second opinion if that feels right for you. If and when you're ready, talking to other people who have gone through this experience may also be helpful.

Summary

If an imaging test yields concerning results, your healthcare provider may recommend getting a breast biopsy to check for cancer.

Fine needle aspiration, core needle biopsy, and surgical (open) biopsy are the most common types of breast biopsies. The kind recommended for you will be determined by various factors, including the size, shape, and appearance of a suspicious lump or breast skin.

If your biopsy is positive for cancerous cells, additional testing will be done, and a treatment plan will be put in place.

14 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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By Corey Whelan
Corey Whelan is a freelance writer specializing in health and wellness conntent.