Minimally Invasive Surgery For Benign Breast Lump

Breast lump is one of the most common complaint by women attending breast clinic. In women younger than 30 years old, the commonest diagnosis of breast lump is fibroadenoma, which is a benign (non-cancerous) breast condition. 

Other common benign conditions of the breast include fibrocystic changes, sclerosing adenosis and ductal hyperplasia.

Diagnosis of benign breast disease is usually done by clinical examination, imaging, and fine needle/ core biopsy; known as the triple assessment, together they give sensitivity of 99%.

In the past, benign (non-cancerous) breast lumps that have been planned for removal would have all been removed by an open surgical procedure (excisional biopsy). Open surgery can be done under general or local anaesthesia and required an incision in the breast. Currently there is a new technique available (vacuum assisted excision biopsy) which can serve as an alternative to surgical excision for women who desire excision but prefer to avoid surgery.  

What is vacuum assisted excision?

Ultrasound guided vacuum-assisted excision biopsy is a non –surgical procedure that can be used to remove benign (non-cancerous) lumps in the breast. A needle is inserted into the breast which uses a combination of sucking and cutting to remove the breast lump. The aim of the procedure is to continue using the biopsy device until the lump visible on ultrasound is removed.

How will it be done?

A local anaesthetic injection into the skin of the breast at the site of the lump and needle tract will be given. An incision a few millimetres long is made in the breast and a 10- or 12- gauge needle attached to a suction device is inserted into the area of the lump. Small amounts of tissue are sucked away through the needle, and this is repeated until the lump appears to have gone. The doctor uses ultrasound to monitor the procedure to see that the lump is removed completely. After the lump removal, the needle device is taken out and pressure is applied for a short time to help stop bleeding. 

Advantages Of Vacuum Assisted Excision Biopsy

• Can be done as an outpatient procedure, no admission required
• Can be done under local or general anaesthesia ( depending on the size and number of lumps)
• Smaller incision, better aesthetic outcome as less scarring
• Shorter recovery time
• Multiple lumps can be excised in the same procedures with minimal incisions

Risks of Vacuum Assisted Excision Biopsy

• There is a small risk of bleeding, in very rare instances, this may require open surgery
• Hematoma formation ( a blood filled swelling) at the site of the lump removed
• Infection
• Feeling faint during the procedure (when performed under local anaesthesia)

Most patients experience mild to moderate pain after the procedure and are relieved by oral painkiller. Sometimes bits of the lump may be missed, this may require repeat procedure or surgery later depending on the type of lesions and monitoring. In rare circumstances, the lesion may turn out to be cancerous after the procedure even if the biopsy before this showed that the lump was benign (non- cancerous).

In summary, vacuum assisted excision biopsy of benign breast lump is a safe, effective, well-tolerated and minimally invasive procedure for the complete removal of benign breast lumps. The minimal scarring and better aesthetic outcome of the procedure has made it a popular choice in breast centres worldwide for women receiving benign breast lump excision.