Breast Biopsy: Who Needs One, What to Expect, and More

If you find a lump in your breast or have an abnormal mammogram finding, you may need to get a breast biopsy. Understandably, this can be a very stressful experience.

A breast biopsy is the only test that can diagnose or confirm breast cancer. It can also show that something isn’t breast cancer. Fortunately, most breast biopsies don’t turn out to be cancer. But getting a biopsy is the only way to know for sure.

Here, we’ll walk you through everything you need to know about getting a breast biopsy — including why you may need one, the different types of biopsies, and what you can do to prepare for it.

What is a breast biopsy?

A breast biopsy is a procedure that removes a small sample of breast tissue for testing. The tissue is sent to a lab where specialized doctors called pathologists examine it and make a diagnosis.

Reasons a breast biopsy may be needed

There are many different reasons you may need a breast biopsy, including things like: 

• A new a lump or thickening in your breast

• Unusual changes in your nipple, like bloody discharge

• A concerning area (lesion) seen on a mammogram, ultrasound, or magnetic resonance imaging (MRI)

Does a breast biopsy mean cancer?

No. In fact, as many as 80% of breast biopsies turn out not to be cancer. But getting a biopsy is the only way to know if a lesion is or isn’t cancer.

What are the different types of breast biopsies?

There are a couple different types of breast biopsy which we’ll get into below. Which type of biopsy your provider recommends depends on your personal situation, like:

• How large the lesion is and where it is in your breast

• How concerning the lesion is to the radiologist who reviews the mammogram

• If there are two or more concerning lesions

• Which type of biopsy you’d prefer

Here are the different options you may be offered.

Fine needle aspiration

​​A fine needle aspiration (FNA) uses a thin, hollow needle to remove a sample of tissue or fluid from the spot. An FNA is usually a good choice if it’s possible there may be fluid in the lesion, like with a cyst. If your provider can’t feel the spot with their hand, they can do an ultrasound scan at the same time to guide the needle to the right spot.

Core needle biopsy

A core needle biopsy uses a larger, hollow needle to remove a sample of tissue. This is the most common test people have to diagnose breast cancer. That’s because it removes more tissue than FNA. But it doesn’t involve cutting into the breast like with a surgical biopsy.

Sometimes, a spring or suction device might be necessary to get enough tissue. This is called a vacuum-assisted core biopsy. The specialist performing the biopsy may need to insert the needle several times to collect enough tissue for analysis. 

Again, if they can’t feel the lesion by hand, they can use different scans to guide the needle to the right spot. If they use a mammogram, that’s called a stereotactic biopsy. They might also use ultrasound or even MRI. 

In some cases, they leave a small metal clip where the biopsy was. This is to help surgeons find the precise area if you need to have surgery. 

Surgical biopsy

A surgical biopsy is a minor surgical procedure that removes all or part of a worrisome lesion in the breast. This may be a good approach if the area is hard to reach with a needle biopsy. It might also be required if you had a needle biopsy already, but the results weren’t clear. 

There are two types of surgical biopsy:

• An incisional biopsy removes part of the lesion. This biopsy type isn’t common.

• An excisional biopsy removes the entire lesion. Sometimes, a rim of normal tissue around the spot is also removed. This is something called a margin. If the biopsy turns out to be cancer but the margin is clear, you may not need more surgery.

If the lesion can’t be felt by hand, you may need a minor procedure before the surgery to mark the spot so the surgeon can find it. This is called preoperative localization. Using a mammogram, ultrasound, or MRI, a radiologist places a wire or another marker in the part of the breast that needs biopsy. 

Lymph node biopsy 

If your biopsy shows invasive breast cancer, you may need to have lymph nodes in your armpit removed when the cancer is removed. If cancer spreads, it usually first goes to nearby lymph nodes. Removing those lymph nodes (celled sentinel nodes) lets your provider check if the cancer has spread.

What to expect during a needle biopsy

FNA and core needle biopsies can usually take place in your provider’s office. The procedure may include these steps:

• You will either lie down or sit on the exam table.

• Your provider will clean the area and numb it with an injection of local anesthetic.

• A fine needle or core biopsy needle will remove some breast tissue.

• You’ll have some pressure applied to stop the bleeding, and a bandage. 

How painful is a needle biopsy?

You may feel a pinch, sting, or burn with the local anesthetic injection. After that, you may feel pressure — but not pain — during the actual biopsy. 

What to expect during a surgical breast biopsy

A surgical biopsy usually takes place in a surgical center or hospital outpatient building. The biopsy procedure may include these steps:

• You will lie on an operating table and may get an intravenous line (IV) in your vein.

• You’ll get some type of anesthesia before the procedure. This may be a medication to help you sleep (sedative) or less likely, a general anesthesia. You may also get local anesthesia to numb the area on your breast. No matter what, you won’t be awake during the procedure or feel pain.

• The surgeon will make a small cut in the skin and remove all or part of the lump.

• The cut is then closed with stitches or strips.

• After recovering from the procedure, you will be able to go home — usually on the same day.

How painful is a surgical breast biopsy?

A surgical breast biopsy isn’t painful because of the anesthesia. But you may need some painkillers for a day or so after, as your wound heals.

How best to prepare for a breast biopsy

Here are some tips for how to prepare for a breast biopsy:

• Make sure you get all your questions answered before the procedure. Write them down so you don’t forget any.

• Tell your provider what medications and supplements you take. You may need to stop taking some before the procedure.

• Arrange for transportation if needed.

• Wear comfortable clothes (like a loose-fitting top and comfortable bra) on the day of the procedure.

• Don’t wear jewelry or use deodorant the day of the biopsy.

• Follow any eating or drinking recommendations (NPO guidelines) you are given. 

Tips for recovering from a breast biopsy.

After a needle or core biopsy, the area may feel sore. And you may also have some bruising. It’s a good idea to avoid a lot of physical activity for 1 or 2 days after the procedure.

Recovering from a surgical biopsy will take longer. Here are some tips to help make it easier:

• Avoid strenuous activity and pressure on your chest for 2 weeks.

• Get plenty of sleep, and rest when you feel tired.

• Take pain medications as directed.

• Wear a supportive bra around the clock for the first 3 days.

• Follow given directions to take care of the biopsy site. 

• Apply an ice pack for 10 minutes at a time, a few times a day during the first 1 to 2 days to help with swelling.

How long does it take to get results from a breast biopsy?

It depends on the lab, but it can take anywhere from a few days to 2 weeks to get results back. The results are sent directly to your provider, who will then review them with you and talk about next steps.

What are the risks and side effects of a breast biopsy?

Some risks and side effects of getting a breast biopsy include:

• Pain during or after the biopsy

• Bleeding, bruising, or swelling of the breast

• Getting an infection at the biopsy site

• Scarring or changes in how the breast looks

• Needing more surgery depending on the biopsy results

There is also a small chance that the biopsy results are wrong or don’t give a definite result. This can be worrying and stressful, especially if you have to go through another biopsy and wait for results again. 

What happens if your breast biopsy is abnormal?

Getting any type of abnormal biopsy results can be stressful. Keep in mind that not all abnormal results mean cancer. Depending on the result, you may or may not need more treatment.

Here are examples of abnormal biopsy results you may see on your report.

Biopsy results that show greater risk

Results in this category are not cancer. But they could mean that you may be more likely to get cancer in the future. This might also mean that you may need more surgery to remove the atypical area followed by regular breast imaging (like mammography). Examples of high-risk biopsy results are:

• Atypical ductal hyperplasia (ADH)

• Atypical lobular hyperplasia (ALH)

Biopsy results that show cancer

If there are cancer cells in your biopsy, the report will include more information that will help your care team decide what treatment you may need. Usually, a biopsy report that confirms cancer includes:

• The type of breast cancer

• If the cancer has spread in the breast or not

• If the cancer was completely removed

Depending on your results and situation, the next steps could include more surgery and different medications (like chemotherapy).

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Written by:

Maria Robinson, MD, MBA

Maria Robinson, MD, MBA, is a board-certified dermatologist and dermatopathologist who has practiced dermatology and dermatopathology for over 10 years across private practice, academic, and telehealth settings. She is a fellow of the American Academy of Dermatology and the American Society of Dermatopathology.

Edited by:

Sophie Vergnaud, MD

Sophie Vergnaud, MD, is the Senior Medical Director for GoodRx Health. An experienced and dedicated pulmonologist and hospitalist, she spent a decade practicing and teaching clinical medicine at academic hospitals throughout London before transitioning to a career in health education and health technology.

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