Myths about Breast Cancer Biopsy Procedure
Medically reviewed by: Dr. Jay R. Anam
Overview
A ‘Core Biopsy’ is a procedure in which a tiny piece of the breast lump is excised using a small sutureless incision.
The tissue removed is tested for a variety of markers that not only confirms the presence of a cancer but also gives information about the type, aggressiveness, hormone and chemo-sensitivity of the cancer; and several other data points that helps take treatment decisions personalised to your type of cancer that optimises outcomes.
The tissue removed is tested for a variety of markers that not only confirms the presence of a cancer but also gives information about the type, aggressiveness, hormone and chemo-sensitivity of the cancer; and several other data points that helps take treatment decisions personalised to your type of cancer that optimises outcomes.
Myths about Breast Cancer Biopsy Procedure
Over the last few years, I’ve come across several patients that have raised concerns and I sum them up in their own words:
- “No doctor, no biopsy just excise it. My aunt says if you disturb the tumour cells, they will spread to the entire body!”
- “Why do we need to biopsy a painless breast?”
- “Biopsy is done under local anaesthesia, while excision of the lump under general anaesthesia. Why should I undergo the procedure under local anaesthesia, which I am told is quite painful?”
- “When you can get the entire lump out, why do we need a small chunk?! It’s all a money making business!!”
Let’s address each of these concerns, starting with a basic understanding about core biopsy procedure.
Core biopsy is performed using a special hollow needle mounted on a special spring-loaded gun, which is why it is often referred to as a “Gun Biopsy”.
This spring action allows the needle to move in and out of the lump quickly, acquiring a small cylinder of tissue with each pass through the tissue.
The patient is nearly pain free during as well as after the procedure.For smaller lumps which are not palpable to hand, core biopsy may be carried out under Ultrasonography or mammography guidance.
Sometimes after the core biopsy there may be a small hematoma (blood clot) at that site. The patient may perceive this as an increase in size of the tumour (this may be the reason behind the common misconception that the cancer spreads after the biopsy). This clot which may be associated with minimal heaviness , swelling and discolouration of the skin, resolves within a week.
Breast cancer is the commonest type of cancer affecting women and the incidence is highest in 50 – 69 years age group. Only 6 % of patients have pain as symptom associated with the lump. 83% ladies present with a painless breast lump. The remaining cases present with a nipple discharge, dimpling over the breast or some skin changes.
It is therefore, quite understandable that the patient is reluctant to undergo a biopsy for a relatively asymptomatic lump. Even more difficult is the situation where the diagnosis is purely on a mammography and there is no lump palpable. It is to allay these concerns that I decided to write this blog.
Let’s Fight Like A Girl!
Diagnosis of the disease :
Not all breast lumps are cancers, and not all cancers present as lumps. So core biopsy is a gold standard test to confirm a diagnosis. Till date, hundreds of publications have addressed the subject of a breast biopsy and none of these studies have noted any adverse effect on outcomes related to the biopsy.
To perform Immunohistochemistry (IHC) :
IHC is a special test done on the biopsy sample. It helps to determine the presence of estrogen, progesterone receptors on the cells (2 out of every 3 breast cancers express receptors to the hormones estrogen and progesterone)(1), and grow and spread in response to the secretion of these hormones).
Having this information allows us to consider a class of drugs that block these receptors that dramatically improves outcomes and survival of the patient. Another receptor that is tested is the Human Epidermal Growth factor Receptor-2 (HER2). A class of drugs (the commonest one being Trastuzumab) are extremely effective in tumors expressing this receptor, and reduce the recurrence rate of the disease by approximately 50%.
Decision making for Surgery first or Chemotherapy first
with the added information on the grade of cancer, the type of receptors present we can very well predict how well it will respond to chemotherapy.
Studies have shown that breast conservation is possible in around 35% of the patients who would have otherwise undergone mastectomy (removal of entire breast), had they not been given chemotherapy first. Also, there is evidence to show that aggressive tumours like the one with Her 2 receptors or ones without any receptors (referred to as triple negative breast cancers or TNBC) can be treated more effectively with chemotherapy first followed by surgery.
A randomised controlled trial, CREATE X, as popularly known, was jointly conducted and reported from Japan and South Korea. The trial included 910 patients, concluding that patients with triple negative breast cancer are at advantage, when they receive chemotherapy first.
Surgery when done after chemotherapy, gives an opportunity to pathologically assess the response of chemotherapy on cancer cells. If a pathologic complete response (no cancer cells seen on histopathologic assessment of surgical specimen) is not attained then addition of an oral chemotherapy agent (Capcetabine) can reduce the disease recurrence by 14% and also give a 8% survival advantage.
Highly Sensitive and specific test
In the past, Fine Needle Aspiration Cytology (FNAC) was done as a means to diagnose breast cancer. FNAC is done using a very fine gauge needle.
Only a few cells are obtained for evaluation. As a result, the false negative rate of FNAC is very high. Besides, it is practically impossible to determine an in-situ tumour (precancerous lesion) from an invasive cancer.
The treatment may change dramatically based on this information, since in-situ tumours do not respond to chemotherapy. Core biopsy allows us to get adequate tissue to get all the possible information required to plan further treatment.
Various studies have shown that sensitivity (ability to correctly identify true positives) of core biopsy of breast lump is around 97% while specificity (ability to correctly identify true negatives) was around 98%. In simpler terms, what these values indicate is that core biopsy is the most reliable test to confirm or refute the diagnosis of a cancer, and is considered to be the gold standard for diagnosing a breast lump.
Easy and can be done on a daycare basis
You do not need any admission. It can be done as an OPD procedure or in a radiology suite. After the procedure, you can go about your daily activities as usual.
The therapeutic planning of breast cancer is like figuring out a jigsaw puzzle, where all pieces of information are important to arrive at the most optimum plan for each patient.
The final goals of the treatment are equally important. For some women, especially the elderly, the cosmesis is not such an important aspect of treatment outcome; whereas for a young woman, it may be the most important outcome parameter.
To plan the treatment so that these goals are met without jeopardizing the chance of cure or long-term remission is dependent on several pieces of information and core biopsy is pivotal among them. Dr. Jay R Anam – YouTube
Appointment Form
About Author
Dr. Jay Rashmi Anam
Surgical Oncologists
15+
Year Of Experience
MMC- 2006031309 (2006)
Dr. Jay Anam is one of the best surgical oncologists & breast cancer specialist in Mumbai.
Dr. Jay Anam has Completed his M.Ch. Surgical Oncology training from Tata Memorial Centre. He did his Fellowship in Breast Oncology from Centre Oscar Lambret, Lille, France.
As a breast cancer specialist, he believes in world-class cancer care for all patients.
Let’s Fight Like A Girl!
Latest Blogs
Mammography vs Ultrasound: Which is Best for Breast Cancer?
Home| BlogsMammography vs Ultrasound: Which is Best for Breast Cancer?Receiving a recommendation for breast imaging can be a stressful and confusing experience. You might be wondering why your doctor suggested a specific test, or what the difference is between the...
Can Breast Cancer Cause Back Pain?
Home| BlogsCan Breast Cancer Cause Back Pain? Back pain is an extremely common problem that can affect anyone, regardless of age. It often results from everyday activities like sitting incorrectly, lifting heavy objects, or a simple muscle strain. But have you ever...
Can You Get Breast Cancer During Pregnancy?
Home| BlogsCan You Get Breast Cancer During Pregnancy?Yes, it is possible to get breast cancer during pregnancy. Pregnancy brings many changes to the breasts—lumps, tenderness, and swelling—which can make spotting cancer difficult. This guide explains...
Facing breast cancer surgery is a brave step, and we know the recovery process may feel overwhelming at times. One aspect of recovery many patients encounter is managing surgical drains.
While these medical devices play a crucial role in your healing, they can be intimidating at first. But don’t worry. With the right knowledge and tools, you can manage them confidently and focus on feeling better.
This guide is here to walk patients and caregivers through every step of drain care—from the basics to troubleshooting to emotional support. By the end, you'll feel prepared to tackle this part of your recovery with ease.
Author
Dr. Jay Anam
Breast Cancer Surgeon and Oncoplasty specialist in Mumbai
Introduction
Why are surgical drains important after breast cancer surgery? These small, plastic tubes help remove excess fluids that can build up in your body as you heal. Getting rid of this fluid reduces swelling, prevents complications like infections, and helps your body recover faster.
We’ll cover everything you need to know, including how to empty and clean your drains, spot signs of infection, manage discomfort, and return to daily life with confidence.
Understanding Surgical Drains
To start, it’s helpful to understand what surgical drains are and why they’re used.
What Are Surgical Drains and Why Are They Necessary?
After surgery, your body produces fluid as part of its natural healing process. Sometimes, this fluid needs help draining so it won’t pool under the skin. That's where surgical drains come in.
Types of Drains
There are a few kinds of surgical drains commonly used:
- Jackson-Pratt (JP) drain – Often shaped like a small bulb, this popular option collects fluid that you can measure and empty.
- Hemovac drain – A slightly larger round container, often used for higher drainage needs.
Your surgeon will determine the best type for you based on your surgery.
How Long Will They Stay in Place?
The timeline varies. Most patients have their drains for 7 to 14 days, but it depends on how much fluid they produce. Don’t worry; your doctor will remove them once output slows down.
Step-by-Step Drain Care Guide
Drain care is manageable if broken down into steps. Let's cover the essentials.
How to Empty the Drain Properly
- Wash your hands thoroughly with soap before touching the drain.
- Unplug the bulb or container, holding it upright.
- Carefully pour the fluid into a measuring cup.
- Record the amount and time in a log to share with your doctor.
- Squeeze the bulb to reset the suction before plugging it back in.
💡 Tip: Empty the drains 2-3 times a day, or whenever they’re about half full.
Cleaning & Infection Prevention
- Gently clean around the drain site with soap and water or antibacterial wipes. Avoid tugging or rubbing the area.
- Watch for signs of infection, such as:
- Redness or swelling around the site
- Fever above 100.4°F
- Foul odor or colored drainage
If you notice these, call your doctor.
Best Sleeping Positions
Finding a comfortable position can be tricky. Try:
- Sleeping on your back with pillows under your arms for support.
- If you’re a side sleeper, place a small cushion around the drains for padding and avoid putting pressure on them.
💡 Tip: A drain-friendly post-surgery pillow with built-in pockets can make rest easier.
Showering & Hygiene Tips
Ask your surgeon if showers are allowed. If so:
- Cover your drains with a waterproof dressing or use a surgical drain belt.
- Limit water exposure to avoid infections.
If showering isn’t an option, stick to sponge baths until your doctor gives the green light.
Recognizing and Managing Complications
Sometimes, issues arise. Here’s what to keep an eye on:
When to Call Your Doctor
- Drainage suddenly increases or stops altogether
- Severe pain or swelling
- Fever or signs of infection
Dealing with a Clogged Drain
A frequent issue is a clogged drain. If you notice reduced suction:
- Milk the tube by gently squeezing it to dislodge the blockage.
- If this doesn’t help, notify your healthcare provider promptly.
Signs of Seroma (Fluid Buildup)
Once drains are removed, some patients develop a seroma. Symptoms include swelling, tenderness, or a feeling of liquid under the skin. While many seromas go away on their own, consult your doctor for advice.
Pain & Discomfort Management
-
Pain is part of recovery, but you don’t have to suffer unnecessarily.
Medication vs. Non-Drug Relief
- Use prescribed painkillers as directed.
- Non-medical options, like a cold compress or heating pad (with your doctor’s approval), can help with aches and stiffness.
Gentle Exercises
Simple arm stretches or shoulder rolls can prevent tightness, but avoid anything strenuous. A physical therapist can provide guidance.
Relaxation Techniques
Practice deep breathing or try mindfulness exercises to cope with discomfort.
Diet & Nutrition for Faster Healing
Fueling your body helps tissues heal faster. Focus on:
- Protein-rich foods, like lean meats, tofu, beans, and eggs.
- Anti-inflammatory options, like berries, leafy greens, and nuts.
- Drink plenty of water every day.
- Consider supplements, like zinc or vitamin C, but check with your doctor first.
Physical Activity & Movement Guidelines
Movement helps, but balance is key:
- Begin with light stretches or short walks to prevent stiffness.
- Avoid lifting anything heavier than a few pounds in the first week.
- Your doctor will guide you on when you can resume driving or house chores.
💡 Tip: Use a supportive bra to minimize any strain during recovery.
Emotional & Psychological Support
Caring for drains can feel isolating. It’s okay to have mixed emotions.
Coping with Anxiety
Deep breathing, journaling, or talking to a friend can help manage stress.
Find Support Groups
Connect with others who’ve been in your shoes. Online breast cancer recovery forums or local groups can make you feel less alone.
Mental Health Resources
Don’t hesitate to reach out to a counselor or therapist to process emotions during your recovery.
Emotional & Psychological Support
Caring for drains can feel isolating. It’s okay to have mixed emotions.
Coping with Anxiety
Deep breathing, journaling, or talking to a friend can help manage stress.
Find Support Groups
Connect with others who’ve been in your shoes. Online breast cancer recovery forums or local groups can make you feel less alone.
Mental Health Resources
Don’t hesitate to reach out to a counselor or therapist to process emotions during your recovery.