Breast biopsies are very commonly performed diagnostic procedures because breast abnormalities are unfortunately common. A physician will typically recommend a biopsy if certain symptoms are present, such as a noticeable lump or nipple discharge, or if regular testing, such as a mammogram, yields abnormal results. While these biopsies are often necessary, many people don’t realize that there are several different types of biopsies, all of which carry different risks. Biopsies include two major categories, which are percutaneous biopsies and open biopsies. Fine needle aspiration, or FNA biopsy, is a specific procedure that is percutaneous and tends to carry the smallest number of risks.

The Risks of Open Breast Biopsy
Open surgical breast biopsies are biopsies in which the surgeon will make a laceration on the breast and remove the lump so that the tissue from the lump can be tested. This procedure usually only requires local anesthesia and the surgeon will make the smallest cut possible that will still permit removal of the mass. In some cases, the surgeon will remove the entire mass, which is considered an excisional biopsy, and in others the surgeon will remove only a portion of the mass, which is referred to as an incisional biopsy.
All surgical procedures carry the risk of small side effects, such as infection, hematomas, and bruising, and open breast biopsies are no different. However, they also carry a number of more concerning risks. Since this surgery requires an incision, it carries a much greater risk for infections than less invasive biopsies do. Additionally, this opening means that the surgeon will have to utilize sutures to close the site, which will likely lead to scarring. This opening also greatly increases the chance of bleeding. This bleeding can be either external or internal and can become serious. This type of biopsy frequently utilizes a guiding wire, which can break off into the breast and cause complications. Lastly, it is more likely that this type of biopsy will require general anesthesia and, although it is uncommon, anesthesia can come with it’s own risks, which can include death.

Fine Needle Aspiration
FNA is a percutaneous biopsy, or biopsy that uses a needle puncture rather than a surgical opening. This procedure is often performed under the guidance of ultrasound technology making it highly accurate. A needle with beveled edges is guided into the mass where several small cuts are made in order to scrape cells into the needle. The cells are then placed on a slide to be viewed through a microscope, which makes the results almost instantaneous. Additionally, if the lump is cystic, an aspiration gun can be attached to the needle to suction out the fluid. It is important that this procedure be performed by a FNA doctor because the results will be inconclusive or invalid if the cells are taken from incorrect tissue or if the slide isn’t properly prepared.
In general, fine needle aspiration carries minimal risk, which includes bruising, bleeding, or infection. However, the entry site is microscopic so the likelihood of these side effects occurring is much smaller. Another benefit is that these biopsies rarely require more than local anesthesia so the recovery time and chance of serious complications from general anesthesia are greatly decreased.

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Celina Nadelman, M.D.

1125 S. Beverly Drive #602
Los Angeles, CA 90035
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Call us: 310.702.6701

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