Excisional Biopsy for Breast Cancer

What is a Breast Biopsy?

A Breast Biopsy is a diagnostic procedure for Breast Cancer. The biopsied tissue is then examined for the presence of cancer. 

There are two types of surgical biopsies: 

• Incisional Biopsy - this removes only part of the abnormal area. 
• Excisional Biopsy - removes the entire tumour or abnormal area. 

The procedure is also referred to as an open surgical biopsy.

What is an Excisional Biopsy for Breast Cancer?

Breast excision biopsy is a procedure where the breast tissue containing suspicious breast growth is removed. 

While the procedure can only remove the area of abnormality without a rim of normal tissue, the edge (margin) of normal breast tissue around the tumour may also be removed, depending on the reason for the biopsy.

When is an Excisional Biopsy Required?

Excisional biopsy is indicated when there is an abnormal area in the breast and a fine needle or core biopsy is not possible, or these approaches have yielded inconclusive results. 

Indications for a Breast Biopsy include:

• A lump that the doctor is concerned about,
• A lump that looks abnormal/indeterminate/suspicious on imaging,
• A lump that the patient wishes to have excised,
• An imaging abnormality that cannot be felt; can be a mass lesion or micro-calcification, and
• Abnormalities that the doctor can not feel may require an intra-operative ultrasound to localise them or a preoperative guide wire or localisation with carbon.

Types of Breast Excisional Biopsy

The two methods used for an Excisional Biopsy procedure are:

• Wire Localisation, and 
• Isotope Localisation.

When the abnormality cannot be felt (palpable), it must be localised before removal. This is performed on an outpatient basis under local anaesthesia and sedation.

Excisional Biopsy by Wire Localisation 

Wire localisation is used for lesions that can only be seen on mammograms, such as micro-calcifications. This procedure is performed on the morning of surgery. It will be very similar to a biopsy procedure and is mammogram or ultrasound-guided.

A radiologist inserts a needle into the target area. The needle is removed, leaving behind a thin flexible wire (like a fishing line) that acts as a guide during surgery. The wire is held in place with a dressing.

Excisional Biopsy by Isotope Localisation

Isotope localisation is used for lesions that can be seen on ultrasound.cThis procedure is performed on the morning of surgery. 

While lying down, an ultrasound is used to locate the breast lesions and a small amount of radioisotope is injected either around or on top of the lesions. 

Using a gamma probe, the surgeon can see the target area. It is similar to having a needle biopsy. It is accurate and not painful. The isotope used is safe and disappears in a day.

Excisional Biopsy Surgery

Excisional Biopsy Surgery is performed under general anaesthesia and starts with a small incision in the breast's skin and the abnormality area. 

Whether using localisation techniques or not, an incision is made, and your surgeon will remove the lump or the tissue containing the wire with the imaging abnormality. 

Where possible the incision is made in a cosmetically acceptable place. Particular care will be paid to close breast tissue and in using the correct surgical planes when closing the skin with plastic surgical style absorbable sutures. This is to ensure that the best cosmetic result is achieved. A small waterproof dressing will be applied.

An x-ray or ultrasound of the tissue is performed to confirm the abnormal area is within the removed tissue. 

The incision is closed with dissolvable sutures and covered with a sterile, waterproof dressing which should be left in place until you see me in the clinic with your results. 

The operation takes around 60 minutes, and an open surgical excisional biopsy is usually performed as a day case.

The specimen with the wire in place will be sent to the x-ray department for an x-ray to confirm that the abnormal area with the hook wire has been removed.

When Do I Receive My Biopsy Results?

You will be seen one week after your surgery in the clinic to discuss your results and have a check-up.

Excisional Biopsy Questions

Hospital Stay

Most patients go home on the day of surgery. It is recommended that you be accompanied home by a carer who will stay with you (or very close by) for the first 24 to 48 hours.

Wound Care & Dressing

The stitches are dissolvable, and the dressing is waterproof so that you can shower as normal. Please do not bathe or swim until it has been cleared by your surgeon.

After two weeks your wounds should be healed, and you can remove your dressing. Typically no further dressings. 

Post Op Massage

Perform wound massage for three weeks using moisturiser and firm movements twice daily for 10 minutes.

Return to Work

Depending on your surgery and job, you may need a week-off work. Most patients have their surgery on Friday and are back to work on Monday.

Post Op Driving

You need to be able to make an emergency stop safely. As the seatbelt crosses your chest you will need to wait a week before you can drive safely.

Gym & Exercise

A week before you start back at the gym as usual. You can do lower body exercises such as cycling and walk almost immediately. Listen to your body and if it hurts, stop and wait a few days before trying again. Avoid ‘breast bounce’ for four weeks.

Complications of Excisional Biopsies:

As with any surgery, a breast biopsy may involve certain risks and complications, including scarring, altered breast appearance, infection, poor healing and bleeding.

• Postoperative Pain: Most women will not have significant pain postoperatively. Paracetamol is recommended strictly and regular for 72 hours after the operation.
• Infection of the wound occurs in a very small percentage of cases, up to approximately 4% and is usually well treated with oral antibiotics.
• Bruising, bleeding, and haematomas are common after breast surgery and do not require a return to theatre. However, occasionally a return to the theatre to evacuate a haematoma is required. The patient should be aware of sudden swelling in the breast, which may indicate bleeding requiring further surgery.
• Scarring and changes to the size and shape of the breast can also occur. Hypertrophic or keloid scarring tends to be more common in patients with highly pigmented skin. Consideration is always given to the scar placement, and at all costs, every attempt should be made to ensure that scars are not placed in the décolletage. The best scars usually heal where the incision is made around the areola.

There can occasionally be a need for further surgery, particularly if cancer cells are found unexpectedly at operation.

There are also rare problems with the insertion of the guide wire itself, and this can occasionally cause some discomfort and bruising to the breast. Sometimes, more than one wire is required to be placed, and this may make patients feel faint. 

A nurse is accompanying the patient at all times. An extremely rare side effect of guide wire insertion is the collapse of the lung (pneumothorax).

In some cases, when a hook wire is placed, the abnormality will not be found in the retrieved tissue. There are several reasons this can occur - in particular, the hook wire may move in the breast during the patient's transit from the radiology department to the operating suite. 

There are also other technical reasons why this can occur. This problem would usually require a return to the theatre at a later date and a re-localisation of the abnormality with a wire.



Some patients will feel tired and have postoperative nausea and vomiting after a general anaesthetic. Allergic reactions to anaesthetic drugs are very uncommon.