Excisional
Breast Biopsy (Lumpectomy)
Description
Excisional biopsy may be performed
with general anesthesia or under local anesthesia
with or without IV sedation.
Excisional breast biopsy is removal of an abnormality
in the breast typically for diagnosis.
The aim of the surgery is to determine
the nature of the mass and to rule out
carcinoma. The lump may be small or large;
however, the nature and breast size
are important factors in determining risk of
complications. A non-palpable mass will
usually require a form of localization (see
next case). Preoperative workup
includes mammogram (especially in women aged
>30–40 years as tumor may be
obscured by the density of younger breast tissue) and
ultrasound (for assessing solid,
cystic, or malignant characteristics). A diagnostic
fi ne- or core-needle biopsy is
usually performed prior to excisional biopsy, under
MMG or U/S guidance if required. Incisional biopsy for diagnosis may be
included
under this risk profi le; however,
excisional biopsy aims to remove the entire lesion,
often with a “cuff” of normal tissue. The incision chosen may be
peri-areolar,
horizontal, or even radial according
to the location and desired cosmesis. Dissection
usually aims to excise a margin of
normal tissue around the lesion, often including
pectoral fascia. Electrocautery, and
deep, absorbable suture closure, is used
for hemostasis, often avoiding wound
drains. Marking sutures are usually used to
orientate the specimen to defi ne
pathological margins.
