Excision or Open Biopsy of a Breast Lump Your Operation Explained

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1 Excision or Open Biopsy of a Breast Lump Your Operation Explained Patient Information

2 Introduction This leaflet tells you about the procedure known as excision or open biopsy of a breast lump. It explains what is involved, and some of the risks associated with this procedure. It is not meant to replace the discussion between you and your surgeon, but helps you to understand more about what is discussed. The diagnosis You have a lump or abnormal area in the breast and your surgeon has advised you to have an excision or biopsy. What are these procedures? An excision biopsy or open biopsy is a small operation to remove a lump or an area of abnormal breast tissue. This operation gives your surgeon information about whether the lump is benign (noncancerous) or malignant (cancerous). Although this can be a worrying time you should be assured that many breast lumps are benign and are not caused by cancer. What happens during the operation? In the majority of cases your operation will be done under a general anaesthetic. This means that you will be asleep throughout the procedure. Alternatively a local anaesthetic could be used. This means that you will be awake during the procedure, but you should feel no pain. This decision will be made based on the size and location of the lump, your preferences and your general health. A cut is made in the skin over or near the area to be removed. Only the lump is removed. The tissue (lump) removed will be sent to the pathology laboratory where it can be analysed and a diagnosis made. Your surgeon will inform you of the results at your next outpatient appointment which should normally be in about two weeks time. Wire guided or ultrasound skin mark biopsy what happens if the surgeon cannot feel the abnormal area? Ladies who attend for a routine mammogram may occasionally be found to have an abnormal looking area on the X-Ray that cannot be felt. In many cases, your surgeon may recommend that this area is removed so we can be certain of the diagnosis. To help the surgeon find the area that needs removing you may have an 1

3 ultrasound scan on the day of surgery and a pen mark put on the breast. The other method is to put a fine wire with a hook into the breast. This is done in the breast unit with you awake using a local anaesthetic injection to numb the breast. The wire is inserted into the abnormal area. Later on when you are asleep, the surgeon can then follow the wire deep into the breast to found the area that needs to be removed. What are the risks of surgery? Complications resulting from this operation are rare and seldom serious. Possible risks are: Bruising and swelling. Bleeding from the wound. To prevent bleeding after the procedure, a gauze pressure dressing may be strapped over the wound. If bleeding happens after your discharge you should contact the breast care nurses or the ward immediately. Infection. If your wound becomes inflamed, red, hot, sore or oozes pus you should contact your GP or the breast unit. In some cases antibiotic treatment may be required. What are the benefits of surgery? The information gained by doing this procedure will assist you and your doctor to make informed decisions about the need for any further treatment. There may be no need for further treatment. However if your results show that the lump was malignant (cancer), then it is possible that you will need a second operation or some other treatment. What are the alternatives to this operation? There is not really a suitable alternative to this operation. The initial investigations did not enable a definite diagnosis to be made. A biopsy is the next stage. In some cases if the surgeon is confident that your lump is benign, you may wish not to have surgery and instead to be regularly monitored in future. If this happens your surgeon will give you more details about why your lump is believed to be benign, how often you will need to be monitored, and what symptoms your doctors will be looking out for. 2

4 What are the consequences of treatment? Aches and twinges are common and may be felt in the wound for up to six months. There may be numb patches around the wound as a result of bruising of the nerves caused during surgery; these should improve after two to three months. There may also be some scarring. What should I do to recover from the operation? If you have had a general anaesthetic you must not drive home. If you had a local anaesthetic we would advise you not to drive home. If you are travelling on public transport it is best to have someone accompany you. It is usually advisable to have someone to help you for the next day or so. Relax as much as you can and take plenty of rest. You should avoid strenuous activity or heavy lifting until after any stitches have been removed and your wound feels more comfortable. Please remember the day procedures unit and the surgical wards, or your own GP, may be contacted for further advice. How should I care for the wound? You may have a bath or a shower after 24 hours but avoid using talcum powder on the wound site. Your doctor will advise you when you can remove the dressing. You should keep the wound clean and dry. A little blood staining of the dressing is normal. If bleeding continues, telephone the hospital for advice. Bleeding can also show up as painful swelling under the skin. It is advisable to wear your bra as you may be bruised and swollen for several days. A bra will give your breast some support, and it can help to wear one whilst you sleep. Your bra should be comfortable, supportive and well fitted. Your wound will probably be closed with stitches (sutures) that will dissolve. Occasional, your surgeon may use stitches that need removing between 7 and 10 days. Your medical team will tell you which type of stitches are being used for you. If your stitches need removing then you will need to make another appointment to have this done. 3

5 You may use a simple, unperfumed moisturiser on your wound when it has completely healed, this will help to remove any scabs. What pain will I be in? Some pain after your operation is normal and usually worst for the first two days after surgery. The pain should get better as your wound heals and you may find that taking paracetomol or other painkillers helps. Eating and drinking Drink plenty of fluids. Eat plenty of fresh fruit and vegetables to prevent constipation that may occur when taking pain relief tablets. Avoid heavy meals, small snacks are better. Returning to work If you work then you can return to work as soon as you feel well enough. However, you may find it advisable to wait until your stitches have been removed. You can discuss this further with your nurse if you wish. Driving It is unlikely that this operation will prevent you from driving except on the day of surgery. Further outpatient appointments You will be given an appointment to come into the outpatients department around two weeks after your operation. Your consultant will then be able to give you the results of the laboratory tests that were performed on the lump that you have had removed. You will have an opportunity to discuss these results and any additional proposed treatment if this is necessary. Many patients find it helpful to invite their partner or a friend or family member to this appointment. Further contacts Surgical wards Day centre It is important that you make a list of all medicines you are taking and bring it with you to all your follow-up clinic appointments. If you have any questions at all, please ask 4

6 your hospital doctor, oncologist or nurse. It may help to write down questions as you think of them so that you have them ready. It may also help to bring someone with you when you attend your outpatient appointments. Glossary of medical terms used in this information: Anaesthetic: a drug that causes a loss of feeling or sensation. Biopsy: a procedure in which a small piece of tissue is removed and examined under a microscope. Mammogram: An X-ray image of the breast, used to detect tumours or other abnormalities. Pathology laboratory: a place where samples of a patient's tissue or body fluids are examined under a microscope to find out more about their disease or illness. For detail of breast cancer support groups in your area, visit our website: Local sources of further information You can visit any of the health/cancer information centres listed below: Heart of England NHS Foundation Trust Health Information Centre Birmingham Heartlands Hospital Bordesley Green Birmingham B9 5SS Telephone: Cancer Information and Support Centre Good Hope Hospital Rectory Road Sutton Coldfield B75 7RR Telephone: Sandwell and West Birmingham Hospitals NHS Trust The Courtyard Centre Sandwell General Hospital (Main Reception) Lyndon 5

7 West Bromwich B71 4HJ Telephone: Fax: University Hospital Birmingham NHS Foundation Trust The Patrick Room Cancer Centre Queen Elizabeth Hospital Edgbaston Birmingham B15 2TH Telephone: Walsall Primary Care Trust Cancer Information & Support Services Challenge Building Hatherton Street Walsall WS1 1YB Freephone: About this information This guide is provided for general information only and is not a substitute for professional medical advice. Every effort is taken to ensure that this information is accurate and consistent with current knowledge and practice at the time of publication. We are constantly striving to improve the quality of our information. If you have a suggestion about how this information can be improved, please contact us via our website: This information was produced by Pan Birmingham Cancer Network and was written by Consultant Surgeons, Clinical Nurse Specialists, Allied Health Professionals, Patients and Carers from the following Trusts: Heart of England NHS Foundation Trust Sandwell and West Birmingham NHS Trust University Hospital Birmingham Foundation Trust Walsall Hospital NHS Trust We acknowledge the support of Macmillan in producing this information Pan Birmingham Cancer Network 2010 Publication Date: September 2010 Review Date: September

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