Breast Biopsy 101: Answering Common Questions with Breast Surgeon Dr. Heather Richardson in Beverly Hills

An image-guided core needle biopsy uses imaging to locate an area of concern in the breast and collect small tissue samples for examination. These samples help determine whether a finding is benign, abnormal, or cancerous. Breast biopsies may be performed by radiologists or breast surgeons with appropriate training and experience. The technique used depends on the location and characteristics of the area being evaluated.

Common approaches include ultrasound-guided, stereotactic mammogram-guided, and MRI-guided biopsies. Although the goal is the same, the experience and procedure length can vary depending on the imaging method and complexity of the biopsy.

Why is imaging repeated before a breast biopsy?

The first step of a breast biopsy is typically confirming that the area of concern can be identified before proceeding with tissue sampling. To do this, your radiologist will usually repeat the same type of imaging that originally prompted the biopsy recommendation, whether that is a mammogram, ultrasound, or MRI. This is a normal and expected part of the biopsy process.

Can my breast biopsy be canceled or the recommendation change on the day of my appointment?

Although uncommon, there are situations where a radiologist may determine that a biopsy is no longer necessary or cannot be safely performed. For example, this can happen during MRI-guided biopsies when the blood flow pattern that initially raised concern has changed or is no longer visible on imaging. In other cases, the area may appear less suspicious than initially thought or may be located too close to the skin, chest wall, lungs, or a breast implant to safely perform the biopsy. If this occurs, your care team may recommend follow-up imaging to monitor the area or suggest a surgical biopsy if tissue sampling is still necessary.

Should I tell my care team about any allergies before a breast biopsy?

Yes. Before beginning the biopsy, your care team will clean the skin using an antiseptic solution, such as iodine, ChloraPrep, or Hibiclens. If you have any allergies to skin cleansers, local anesthetics, adhesives, or other materials commonly used during a biopsy, it is important to notify the center ahead of time. You should also remind your care team of these allergies at the beginning of your appointment, as biopsy equipment and supplies may have been prepared in advance.

Will I feel pain during a breast biopsy?

Before the biopsy begins, your provider will inject a local anesthetic to numb the area. You may feel a brief sting or pinch during the initial injection, but this typically lasts only a few seconds. Techniques such as using a smaller needle, buffering the anesthetic to reduce its acidity, or using gentle tapping or vibration can help minimize discomfort.

Typically, more than one injection is needed. The first numbs the skin, while a second delivers anesthetic deeper into the breast tissue. As the deeper injection is administered through the already numbed skin, it is usually less noticeable.

It is important to understand that the point where the biopsy needle enters the skin is usually different from the actual biopsy site. The needle must travel through the breast tissue to reach the area of concern, allowing your provider to visualize its approach and accurately collect tissue samples. Local anesthesia typically lasts one to two hours. If you have concerns about pain or discomfort, communicate them to your care team beforehand so they can help make the experience as comfortable as possible.

What should I expect during the breast biopsy itself?

Even with local anesthesia, it is normal to feel some pressure, tugging, or movement during a breast biopsy. While you should not experience sharp pain, you may still feel sensations as your provider collects tissue samples. The length of the procedure depends on the type and complexity of the biopsy. A simple ultrasound-guided biopsy may take less than five minutes, while a stereotactic or MRI-guided biopsy can take 30 minutes to an hour or longer.

In some cases, particularly when sampling calcifications, your provider may take an X-ray of the collected tissue to confirm that the area of concern was adequately sampled. If the images do not show enough of the targeted tissue, additional samples may be needed, which can extend the procedure. For this reason, the biopsy is not considered complete until your provider confirms that sufficient tissue has been collected and the final dressing is applied.

What happens immediately after a breast biopsy?

After the biopsy, a member of your care team will typically apply pressure to the needle insertion site and surrounding breast tissue to minimize bleeding and bruising. This may take anywhere from 10 to 30 minutes, depending on the procedure.

The insertion site is usually closed with small adhesive strips called Steri-Strips. For patients with adhesive sensitivities, skin glue or sutures may be used instead. If a stitch is necessary, it is typically placed while the area is still numb and is often absorbable, meaning it does not need to be removed.

The biopsy incision is generally very small, approximately 2 to 3 millimeters, and typically results in minimal scarring. When possible, your provider may choose an insertion site along the edge of the areola or within an existing surgical scar to make the mark less noticeable. However, the location ultimately depends on the safest and most effective approach to the area being biopsied.

Bruising, swelling, and temporary firmness are common after a breast biopsy. Because the biopsy device passes through breast tissue containing blood vessels, some bleeding and inflammation are expected. The amount of bruising varies, and a larger bruise does not necessarily indicate a complication.

The body's natural healing response may also cause the area to feel harder or lumpier than before. This firmness can develop within the first one to two weeks and may take several weeks or occasionally months to resolve.

A new or firmer lump after a biopsy does not necessarily mean the original finding is growing. However, contact your care team if you notice worsening pain, significant swelling, persistent bleeding, spreading redness, fever, or other concerning changes.

Sometimes people have to have biopsies of the nipple or nipple area. Sometimes they’re under the impression that a needle is going to go directly into their nipple. At least when I do this, this isn’t the case. We usually gently place the numbing medicine at the base of the nipple or at the areolar margin which is very well tolerated. Once we sneak the numbing medicine into the base, the nerves to the nipple are usually numbed and we can proceed with what is called a punch biopsy, which is a tiny cookie cutter that takes essentially a sample of the skin inside the nipple. This usually take less than five minutes.

Punch biopsies are also sometimes performed on other areas of the skin that we want to sample, either because we want to know what’s going on with the skin itself, and it just happens to be skin on top of the breast, or because we’re worried about a breast cancer process that’s communicating with the skin. Either way, this is performed after the skin is cleaned and numbed with a tiny cookie cutter type device. Usually one or two samples are taken. This can be dressed with a Steri-Strip or a small suture can be placed in numb tissue.

Biopsy results typically take one to two weeks, although some may be available sooner. The timing depends on the tissue analysis required and the laboratory processing involved. Waiting for results can be stressful, but the amount of time it takes to receive them does not reliably indicate whether a finding is benign or cancerous.

Once the results are available, your provider can explain what they mean and whether additional imaging, monitoring, treatment, or surgical removal is recommended. Some findings may also affect your assessment of future breast cancer risk.

Being told you need a breast biopsy can feel overwhelming, but it is important to remember that a biopsy recommendation does not mean you have breast cancer. A biopsy is simply a way to get more information about an area of concern and determine the appropriate next steps in your care.

Understanding what happens before, during, and after the procedure can help you feel more prepared and know what to expect. Every biopsy is different, and your experience may vary depending on the type of imaging used, the location of the finding, and your individual needs.

At Bedford Breast Center, we believe patients should feel informed and supported throughout every step of their care. If you have questions about a recommended biopsy, your results, or what comes next, our team is here to help you understand your options and make informed decisions about your breast health.