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Breast procedures

Our Breast Diagnostic Centers provide several specialized breast procedures, including cyst aspiration, biopsies, needle localization and ductogram. Read more about each procedure and how to prepare below.

Cysts are small pockets of fluid in the breast that may feel like a lump, or may be first noticed on a mammogram. Ultrasound frequently can confirm that such a finding is a cyst and thus benign. Occasionally, it may be necessary to aspirate a cyst to prove that it is a cyst and not a tumor.

Procedure

Cyst aspiration is most accurately performed under ultrasound guidance. With the patient lying down, the skin is first cleansed, and local anesthesia may be used, if necessary. While watching the cyst with ultrasound, a small needle is placed through the skin, into the cyst, and as much fluid as possible is removed. This procedure is quick and most patients tolerate it well, with little to no discomfort. If fluid is obtained, it may need to be sent to the lab for analysis. You will usually be released immediately following the procedure. If a specimen is sent to the lab, we will call you with lab results as soon as we receive them; usually in 2-3 working days.

A possible abnormality, or “lesion” on your mammogram can be evaluated in one of two ways. Either it is “followed” over a period of time with mammography and/or ultrasound to see if there is a significant change, or a biopsy is done to remove samples of the tissue.

Lesions are “followed” if it is felt they are extremely likely to be benign. Biopsies are done if an area is more worrisome in appearance, or just not specific enough in appearance to wait for follow up. Also, biopsy can be done if a patient is not comfortable with the idea of waiting four to six months for follow up.

It’s good to remember that around 80% of lesions are benign.

Biopsy can either be done in our office (needle biopsy), or in outpatient surgery (surgical excisional biopsy). Stereotactic, ultrasound, and MRI biopsies are all types of needle biopsy, which is the least invasive way to obtain a tissue sample for diagnoses. It is accurate, requires less recovery time than a surgical biopsy, and there is not significant scarring to the breast.

Suspicious areas or lumps which can be seen with ultrasound can now be accurately biopsied with ultrasound guidance. A Core Biopsy needle can retrieve thin cylinders of tissue from the area of concern in the breast without surgery.

Preparation for procedure

If you are on any blood thinners, such as heparin, coumadin, or even ASPIRIN, you will need to inform us as soon as possible. You may need to be off blood thinners for as long as five to seven days before the biopsy.

You can take your other medications, and eat your usual meals before the biopsy.

Procedure

The needle biopsy procedure is performed by a breast center physician, with assistance from a radiologic (x-ray) technologist.

After arriving at the office, you will undress from the waist up and change into a hospital gown, and you will be escorted to the ultrasound room. The technologist will ask you to lie down on the ultrasound table, making sure you are as comfortable as possible. An ultrasound will be performed to re-locate the area in question, and that general area of your skin will be cleansed with surgical soap. Next, the physician will numb the entire biopsy area by injecting a local anesthetic called lidocaine into your breast. This will be done with a very tiny needle, and you may feel a brief sting in your breast at the injection site.

After the local anesthetic has taken effect, the physician will advance the biopsy needle into your breast at the numbed area, while confirming position of the needle with ultrasound. Once placement is confirmed, the physician will acquire several tissue samples. Then pressure is applied to the biopsy site to prevent bleeding, and an ice pack is applied to reduce any possible bruising. You will not need any stitches. You will go home with printed post-procedure care instructions.

Preparation for procedure

If you are on any blood thinners, such as heparin, coumadin, or even ASPIRIN, you will need to inform us as soon as possible. You may need to be off blood thinners for as long as five to seven days before the biopsy. You can take your other medications, and eat your usual breakfast before the biopsy.

Procedure

The stereotactic needle biopsy procedure will be performed by one of our breast center physicians who specialize in stereotactic core needle biopsy, with assistance from a radiologic (x-ray) technologist, also with a background assisting in this procedure.

After arriving at the office, you will undress from the waist up and change into a hospital gown, and you will be escorted to the biopsy room. The technologist will ask you to lie face down on the special procedure table, making sure you are as comfortable as possible. Your breast will be positioned though a special round opening in the table. The table will then be raised so the physician and technologists can work from below. The first part of the procedure will seem much like your mammogram, except that you are lying down instead of standing up. Your breast will be compressed with a compression paddle just as it was during your mammogram. An x-ray will be taken to ensure that the area of breast containing the lesion is correctly centered. With the help of a computer connected to the mammography machine, the exact position of the biopsy is determined. Next, the physician will numb the entire biopsy area by injecting a local anesthetic into your breast. This will be done with a very tiny needle, and you may feel a brief sting in your breast at the injection site.

After the local anesthetic has taken effect, the physician will advance the biopsy needle into your breast, at the numbed area. A set of x-rays will then been taken to ensure proper needle placement. Once placement is confirmed, the physician will acquire tissue samples. When the physician has retrieved all the samples, a tiny (1/8”) metal clip will be left in place to permanently mark the biopsy site. You will not be able to see or feel this clip, but it is extremely helpful in confirming accurate biopsy and in assessing your mammograms in the future. Placing this clip is an absolute requirement of this procedure. The compression paddle will be released from your breast and the technologist will then apply pressure to the biopsy site for five to ten minutes to prevent bleeding, and reduce any possible bruising. Next, a regular mammogram will be obtained, which will serve as a useful baseline for future mammography. Afterwards, a dressing will be applied which you will wear home. You will not need any stitches. You will go home with printed post-procedure care instructions.

Preparation for procedure

If you are on any blood thinners, such as heparin, coumadin, or even ASPIRIN, you will need to inform us as soon as possible. You may need to be off blood thinners for as long as five to seven days before the biopsy.

You can take your other medications, and eat your usual breakfast before the biopsy.

Procedure

The MRI-guided needle biopsy procedure will be performed by one of our breast center physicians who specialize in needle biopsy, with assistance from a radiologic (x-ray) technologist, also with a background assisting in this procedure.

After arriving at the office, you will change into a hospital gown, and you will be escorted to the MRI room. An IV will be started. The technologist will ask you to lie face down on the MRI table, just as you did for your Breast MRI. Your breast will be compressed with a compression paddle. MRI images will be taken, and after IV contrast is given, the exact position of the biopsy is determined. Next, the physician will numb the entire biopsy area by injecting a local anesthetic into your breast. This will be done with a very tiny needle, and you may feel a brief sting in your breast at the injection site.

After the local anesthetic has taken effect, the physician will advance the biopsy needle into your breast, at the numbed area. Once placement is confirmed by additional MRI images, the physician will acquire tissue samples through the needle. When the physician has retrieved all the samples, a tiny (1/8”) metallic clip will be left in place to permanently mark the biopsy site. You will not be able to see or feel this clip, but it is extremely helpful in confirming accurate biopsy and in assessing your mammograms in the future. Placing this clip is an absolute requirement of this procedure. The compression paddle will be released from your breast and the technologist will then apply pressure to the biopsy site for five to ten minutes to prevent bleeding, and reduce any possible bruising. Next, a regular mammogram will be obtained, which will serve as a useful baseline for future mammography. Afterwards, a dressing will be applied which you will wear home. You will not need any stitches or sutures. You will go home with printed post-procedure care instructions.

Wire localization is a procedure used to guide a surgeon to a suspicious finding in a breast that cannot be felt, but can be seen on mammogram or ultrasound. The abnormality is often a cluster of tiny calcifications or a nodule too small to be felt.

The radiologist uses either the mammogram machine or ultrasound machine to guide placement of a small needle through the skin to the suspicious finding. A mammogram confirms correct position of the needle. A thin wire is placed through the needle, and the needle is then removed, leaving the wire in place.

A final set of mammograms is obtained with the wire in place. These films accompany you to the surgical suite. The surgeon removes the wire and abnormality in the operating room.

A ductogram is a mammographic procedure performed to help in the evaluation of abnormal nipple discharge. We usually perform a ductogram in conjunction with evaluation of the patient by a surgeon. In ductography, (galactography), the draining duct is identified visually through a magnifying glass, and a tiny catheter is carefully placed into the draining duct at the nipple. After a very small amount of contrast (clear x-ray dye) is instilled, a mammogram is obtained to produce an image of the duct. Blue dye may be added to the clear contrast if the patient is scheduled for surgery the same day. This blue dye temporarily stains the duct, giving the surgeon a visible guide to the draining duct, in addition to the mammogram x-ray image.

If we cannot elicit any discharge on the day of the scheduled exam, the ductogram cannot be performed. However, if the patient is already scheduled for outpatient surgery that day, the surgical procedure can usually still be performed.

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