Have you been asked to have a breast biopsy? Don't worry, we'll talk about it all.

It's normal to feel a little scared and nervous when your doctor tells you to have a breast biopsy. You may think, "Oh, do I have cancer?" But the most important thing to remember is that just because you're being asked to have a biopsy doesn't mean you have cancer. In fact, 80 out of 100 women who have this type of biopsy are found to have no cancer. So let's talk about this in detail without any fear.

Simply put, what is a biopsy?

Simply put, a breast biopsy is a procedure where a very small piece of tissue is taken from a spot in your breast and examined under a microscope. Imagine that you have a lump in your breast. A biopsy is the only way to know for sure whether it is cancerous or not. While other types of scans (Mammogram, Ultrasound) can give you some idea, only a biopsy can tell you for sure.

Why do you need a biopsy?

A doctor will usually suggest that you have a biopsy for one or more of the following reasons:

• Feeling a lump or thickening in the breast: If you notice an unusual lump, lump, or thickening in the breast, either during a self-examination or during an examination by your doctor.
• Abnormal mammogram: If your mammogram report shows a suspicious area.
• Ultrasound scan results: If an ultrasound scan of the breast identifies a suspicious area that could be cancerous.
• Changes in the skin around your nipple or areola: Unusual changes in your nipple or the dark skin around it (areola), for example, crusting, dimpling, or unusual discharge.

What types of breast biopsies are there?

There are several methods for performing a breast biopsy. Depending on the nature of the abnormality in your breast, your doctor will decide which method is best for you. Let's take a look at the main types.

How should you prepare before a biopsy?

Before having a biopsy, you should definitely tell your doctor, surgeon, or radiologist about these things.

• If you are pregnant or may become pregnant.
• If you are taking anticoagulant (blood-thinning) medication, your doctor may advise you to stop taking it or adjust the dosage a few days before the biopsy.
• If you are taking aspirin or other herbal supplements.
• About other illnesses you have and recent surgeries you have had.
• It is very important to tell us about any allergies you have, especially allergies to anesthesia.

Additionally, your medical team will advise you on things like whether or not to use deodorant on the day of the biopsy and whether you need someone to take you home after the biopsy.

What happens before the biopsy is done?

Sometimes, before taking a piece of tissue for a biopsy, other methods are used to mark the exact location of the tissue to be taken.

Finding the right location through scans (Image-guided procedures)

During the biopsy, a scanner can be used to see exactly where to insert the needle. This is called an `image-guided procedure`. The methods used for this are:

• Stereotactic breast biopsy
• Ultrasound-guided biopsy
• Magnetic resonance imaging (MRI)-guided biopsy

Wire or non-wire localization

If you are having a surgical biopsy, a technique called `wire localization` can be used to help the surgeon find the exact area to remove. This involves:

1. First, an anesthesiologist will inject a small needle into the area of ​​your breast to numb it.

2. Then, under the guidance of a scan (e.g., ultrasound, MRI), the surgeon inserts a very fine, hollow needle into the area where the biopsy is to be performed.

3. Once the needle is in the right place, a very thin, sterile wire is inserted through the middle of the needle. This wire has a small hook at the end, so it won't move around.

4. Then the needle is removed. Only the wire remains inside the breast. The protruding part of the wire is visible.

5. After the surgery is complete, this wire is completely removed.

Similarly, other modern methods such as small magnetic devices and radioactive devices are now being used to mark locations.

What happens during a biopsy?

The experience may vary slightly depending on the type of biopsy you have.

• In the case of a Fine Needle Aspiration (FNA) biopsy: The doctor will numb the area (local anesthesia) and insert a needle to obtain a small sample of cells and fluid.
• A Core Needle Breast Biopsy: The radiologist numbs the area, perhaps makes a very small incision in the skin, inserts a needle, and takes a sample of tissue. A small mark (a `biopsy marker`) is then placed to mark the site of the sample. This allows the surgeon to find the exact location of the sample if additional samples are needed later or if surgery is needed.
• If it's surgery (like a lumpectomy): The anesthesiologist will put you under general anesthesia. The surgeon will then make an incision in your breast and remove the affected area of ​​tissue. The incision will then be closed with stitches and a sterile dressing.

How long does this take and how long does it take to heal?

Are there any risks and complications with this?

As with any medical procedure, there are some risks involved. But don't worry, serious complications are very rare .

• Common things that can happen:
• Bruising
• Bleeding
• Swelling
• Pain or difficulty healing
• Surgical wound infection
• Very rare complications:
• Blood collection inside the breast (breast hematoma)
• Damage to a lung (pneumothorax)

What does the biopsy report say?

Your tissue sample is examined by a pathologist. Depending on the results, it can be determined whether it is benign, cancerous, or precancerous.

What if it is confirmed to be cancer?

If the result is cancer, don't panic. Your doctor will provide you with all the support and guidance you need. The report may include the following:

• Tumor type: Whether it is `invasive` (spreads into surrounding tissue) or `noninvasive` (stays in one place and does not spread).
• Tumor grade: How fast the cancer cells divide and how similar/unlike they are to normal cells.
• Hormone receptor status: Hormones help some cancers grow. This tells you whether your cancer is hormone-dependent, such as estrogen receptor-positive (ER+).
• HER2 status: `HER2` is a protein that helps cancer cells grow and spread. This can tell you whether your cancer is `HER2-positive` or not.

How long does it take for the results to come back? When should I talk to the doctor?

It usually takes about a week to two weeks to get the biopsy results. We know this can be a stressful time. That's normal. Keeping up with your normal activities, doing things you enjoy, and talking about your feelings with someone you trust will help you through this time.

If you experience any of these symptoms, call your doctor immediately:

• Fever (over 38.4 Celsius / 101 Fahrenheit).
• Redness or unusual darkening of the skin around the biopsy site.
• Feeling severe pain when touching that area.
• Unusually widespread scarring .

What other conditions look like cancer, but are not cancer?

Yes, not every lump or change in the breast is cancer. There are many non-cancerous (benign) conditions that can show signs of cancer.

• Fibroadenoma: These are a common type of non-cancerous lump.
• Breast calcification: Calcium deposits in breast tissue.
• Cysts: These are fluid-filled sacs that can be painful.
• Fibrosis: Breast tissue becomes thickened and hard due to hormonal changes.

So, when the doctor asks you to do a biopsy, it's just to confirm exactly which of these conditions you have.

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