About breast lumps
Overgrowth of tissue in the breast can cause breast lumps. The vast majority are benign (ie not due to cancer). If a lump is filled with fluid, it is known as a cyst.
Having a breast lump investigated
Breast clinics use a system called triple assessment to diagnose breast lumps as quickly as possible. Triple assessment means that there are three stages:
- examination
- imaging
- biopsy
Breast examination
In a private room or cubicle, you will be asked to remove all your clothes above your waist. Your surgeon will examine your breasts and armpits, pressing gently on the skin to feel any changes in texture.
Breast imaging
A picture of the inside of your breast may be needed to see where the lump is. This is called imaging. Imaging is normally done in the X-ray department by a specially-trained breast radiologist. There are a number of ways to get images of the breasts.
- Ultrasound uses high-frequency sound waves to create a picture of the tissues on a computer screen. This involves putting some gel on your breast and moving a sensor over the skin. Ultrasound is painless and only takes a few minutes.
- Mammography uses X-rays to create a picture of the breast. Mammography is usually done while you are standing up. The breast is pressed between two plastic plates to keep it still. This may be a bit uncomfortable, but it takes less than a minute.
- Stereotactic guidance uses X-rays to create an image of the breast in a similar way to mammography. A computer calculates information from the pictures, and positions a biopsy needle in the correct place (so the imaging and biopsy stages are done at the same time).
Different types of biopsy
If a breast abnormality has been found during an examination, or seen on an image, you may need a biopsy to find out whether it is harmless or cancer. There are a number of different types of biopsy. This leaflet describes fine needle aspiration, core biopsy and vacuum assisted core biopsy. Your surgeon will explain which is most suitable for you.
Fine needle aspiration (FNA)
Your surgeon will put a thin needle through the skin of your breast (usually just once). You may find it uncomfortable when the needle is inserted, but local anaesthesia is often not necessary. Your surgeon will direct the needle into the lump several times and draw some cells out into the syringe. This only takes a few minutes. The pin-prick left by the needle is covered with a plaster. You won’t need any stitches.
Core biopsy
A core biopsy is usually done under local anaesthesia. Your surgeon or radiologist makes a tiny nick on the skin over the lump using a fine blade. A special, hollow needle is inserted through this cut. By releasing a spring, a piece of tissue is collected inside the hollow cylinder of the needle. Your surgeon or radiologist may insert the needle several times, so that there are a number of samples to send to the laboratory. The spring action is quite sudden, and does come as a surprise the first time. Your nurse will apply firm pressure to the area for at least five minutes before covering the cut with a plaster or a paper stitch.
Vacuum assisted core biopsy (VACB)
VACB (sometimes referred to by the brand name Mammotome) is done under local anaesthesia. Once the anaesthetic has taken effect your surgeon or radiologist makes a small cut (about 5mm) on the skin over the lump. He or she then inserts a special, hollow probe that is attached to a gentle vacuum pump. This probe sucks breast tissue into the hollow cylinder. A number of samples can be taken without removing the probe.
This type of biopsy is usually done under ultrasound or stereotactic guidance (meaning that the imaging and biopsy stages are done at the same time). The cut will be closed with a plaster or paper stitch. A bandage may be wrapped round your breasts to minimise any swelling.
Using the triple assessment, it may be possible to diagnose a breast lump on the same day. However, a follow-up appointment with your surgeon and specialist breast-care nurse may be arranged to discuss the results of any other tests.
You should be able to return to most normal activities and to work straight away. But don’t do any strenuous lifting or exercise for the first 24 hours. It’s unlikely that you will have noticeable scars after a breast biopsy. However, this can vary from person to person.
About breast lump removal
Surgery is needed to remove small breast lumps that don’t go away on their own or cysts that keep coming back. The operation is known as a lumpectomy. The lump is sent to a laboratory for examination.
In some cases, a border of healthy tissue around the lump may also be removed. This is called wide local excision. The healthy tissue is also examined in the laboratory to find out if the lump has been completely removed.
Lumpectomy is routinely performed under general anaesthesia, which means you will be asleep during the procedure and won’t feel any pain. The operation can be performed as a day-case, but an overnight stay in hospital is sometimes required. During the operation, a cut, slightly bigger than the lump, is made over or near the lump. The lump can now be removed completely. The cut is then closed with fine stitches. The operation usually takes between 45 and 60 minutes.
Afterwards, your arm and shoulder may feel sore and stiff, particularly if the lump was removed from the upper, outer part of the breast. You may feel “pins and needles” or numbness in the underarm skin. This is because nerves here can be irritated or damaged during the operation. This is usually temporary. You should wear a supportive bra, and you may be advised to wear it night and day for the first week or so. If you play sport, always wear a sports bra.
Your surgeon will explain the benefits and risks of having a breast lump removed, and will also discuss the alternatives to the procedure.
Having a breast biopsy or a breast lump removed are commonly performed and generally safe procedures. However, all surgery carries an element of risk.
Your surgeon will be very experienced at doing breast biopsies but, even so, the biopsy may not be able to confirm if the lump in your breast is benign or not. If this is the case you may need to have another biopsy or further treatment (such as breast lump removal). Sometimes, following a breast lump removal, fluid can accumulate at the site of the operation or under the arm (known as seroma). This can feel uncomfortable and push your arm away from your side and you may need to have the fluid drained.
The chance of complications depends on the exact type of procedure you are having and other factors such as your general health. Please ask your surgeon to explain how any risks apply to you.
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