Undergoing Image-Guided Breast Vacuum Biopsy/Excision Biopsy

Introduction

This information leaflet is designed to answer questions which are frequently asked about the procedure known as image-guided breast vacuum biopsy/excision biopsy. It explains what is involved, and what are the possible risks.

What is an image-guided breast vacuum biopsy/excision biopsy?

It is a procedure to take a small sample of breast tissue to make a diagnosis or excise a lesion. An ultrasound or mammogram machine helps to accurately guide the biopsy device through the skin and take a sample from the breast using a hollow needle attached to a gentle vacuum pump.

Who has recommended doing the procedure?

A consultant radiologist or consultant radiographer recommends the procedure as the best way of making a diagnosis. Often this decision is made after discussion with the breast surgeon.

Who will be performing the procedure?

A consultant radiologist, consultant radiographer or an advanced clinical practitioner will perform the procedure.

Where will the procedure take place?

Within the Breast Radiology Unit in the Ultrasound or Mammography room.

Anticoagulant medications or disorders of bleeding/clotting

If you are taking blood clot prevention medication, you must tell the clinician or breast care nurse prior to the procedure. You may be advised to stop taking this medication for a short time before the procedure.

Before the procedure

• Please eat and drink something prior to the procedure to keep your blood sugars up
• Take medications as normal unless advised otherwise (see blood clot prevention medication above)
• Please bring a supportive (non wired) bra to wear after the procedure
• We recommend you arrange for someone to drive you home afterwards, however, if this is not possible you can drive after the procedure, if you feel safe to do so.

What happens during the image guided breast vacuum biopsy/excision?

The procedure will be explained to you before starting the biopsy, and you will be asked to read and sign a consent form. You may be required to change into a gown.

You will be asked either to sit with your breast positioned in the mammogram machine, or to lie on an ultrasound couch. The breast will be re-examined, using the mammogram or ultrasound machine, to determine the best position to place the biopsy device. The skin will be cleaned with an antiseptic to help avoid infection. The skin and deeper tissue will be anesthetised with a local anaesthetic. This will sting briefly before the tissues go numb. A small cut will be made to insert the biopsy device. The position of the biopsy device will be checked, and then one or more biopsies will be taken without removing the biopsy device. A marker clip may be placed at the biopsy site. This is so the area can be identified again if necessary. If you do not require any further treatment the marker is designed to be safe to remain in the breast permanently.

After the procedure

• Staff will apply firm pressure to the area to minimize bleeding and bruising, and a pressure dressing may be applied if required
• You should avoid any strenuous activities for the next 48 hours and keep the area dry, clean and covered
• When the anaesthetic wears off, the breast may become uncomfortable or painful. Paracetamol can relieve this
• It may help to wear a support bra during the day and night following the biopsy.

Will there be anyone else in the room?

Yes. As well as the consultant radiologist, consultant radiographer or advanced clinical practitioner a mammographer may be present to operate mammography equipment and assist in the procedure. A radiology assistant will also be there to take care of you.

How long will it take?

Every patient’s situation is different, and it is not always easy to predict how long the procedure will take. Please allow at least two hours for the whole visit.

Will it hurt?

You may feel stinging as the local anaesthetic is given and then pressure on the skin as the biopsy is performed. If you do experience some discomfort, please inform us as more anaesthetic can be given if needed. You can decide to stop the procedure at any time.

What happens afterwards?

You will not get the results of your biopsy before you leave, as it takes a few days for the pathologist to examine the biopsy specimen. The results will be given to you at a breast clinic appointment. Before you leave, you will be advised how to make this appointment.

We recommend that you stay in the breast unit for at least 45 minutes after the procedure.

After care advice

• If possible, arrange for someone to collect you from hospital
• Ideally, you should take things easy for the rest of the day. Avoid any strenuous exercise for the next 24 hours
• When the anaesthetic wears off, the breast may become uncomfortable or painful. Paracetamol can relieve this. Do not take aspirin
• It may help to wear a support bra during the day and night following the biopsy.

What are the risks and complications?

There are generally few complications with this procedure, though you may experience some tenderness, bruising or swelling around the biopsy site. This can take a week or two to settle.

You may develop a small scar or indentation at the site of the biopsy. There is small a risk of infection. Please contact your GP if:

• There is increasing redness, swelling or bleeding at the biopsy site
• Your temperature is 38 C (100.4 F) or greater
• You experience pain that is not relieved with Paracetamol.

If the biopsy site starts bleeding again after you have left the unit, please apply firm pressure over the dressing until bleeding stops. If bleeding continues for 20 minutes after applying firm pressure please contact us on the numbers below or attend your local A&E Department.

Occasionally the pathologist cannot make a clear diagnosis from the piece of tissue obtained. In these cases, it may be necessary to repeat a biopsy, or to perform a surgical excision biopsy.

We hope that you have found this information leaflet useful. If you have any questions about your appointment, or you are worried about anything, please contact:

Mammography Department: 01305 254530

Breast Care Nurses: 01305 255160

You can also contact NHS 111 – 24 hours a day on 111 or https://111.nhs.uk/

If you have any concerns or issues about your treatment which have not been answered by the Radiology Department, please contact our Patient Advice Liaison Service (PALS) on 0800 7838058 or email patientexperience@dchft.nhs.uk

About this leaflet

Author: Dr Tom Marsh, Consultant Radiologist, Cheryl Stubbs, Consultant Radiographer
Written: July 2025
Approved: July 2025
Review date: July 2028
Edition: v1

If you have feedback regarding the accuracy of the information contained in this leaflet, or if you would like a list of references used to develop this leaflet, please email patientinformation.leaflets@dchft.nhs.uk