Excision Biopsy

Excision Biopsy

General Surgery 

Name of procedure: Excision Biopsy

It has been recommended that you have an excision biopsy of an area of concern within your breast in order for complete laboratory analysis to take place.  Previous core biopsies of this area have been inconclusive.

The operation involves making a cut in the skin of your breast.  The area of concern

is then removed – the majority of the breast itself is preserved.  Detailed laboratory analysis of the removed tissue will help us to advise you and your surgeon if any further treatment is necessary.

This leaflet explains some of the benefits, risks and alternatives to the operation.  We

want you to have an informed choice so you can make the right decision. You and your

doctor will also need to record that you agree to have the procedure by signing a consent

form, which your health professional will give you. Please ask your surgical team about

anything you do not fully understand or want to be explained in more detail.

Benefits of Procedure

The aim of the surgery is to remove the area of concern from your breast in order to

allow for complete laboratory analysis.

Serious or frequent risks

Everything we do in life has risks.  There are some risks associated with this type of

surgery. The general risks of surgery include problems with:

• The wound (for example infection); and
• Blood clots (for example in the legs or occasionally in the lung).

Those specifically related to breast surgery may include problems with swelling of your

breast or change in appearance.

• Swelling – this usually settles over a few months.  Occasionally after an operation

a haematoma (collection of blood) may develop.  This may require an operation to remove it and stop any bleeding vessels.

• Minor skin burn. Due to heat conduction used to stop bleeding during surgery.
• The appearance and shape of your breast may be altered depending on the volume of tissue that needs to be removed and your original breast size.
• It is not uncommon to have altered sensation in the skin of your breast after surgical treatment.  This is sometimes a nuisance but is not harmful and usually improves with time.
• Although your surgeon will ensure a clear margin clinically and on X-ray at the time of your operation, the final results will depend on the laboratory analysis of the removed tissue.  Thus, there is a chance that you will require further surgery.  The results of your operation will be discussed with you at your follow-up clinic visit.

Most people will not experience any serious complications from their surgery. The risks

increase for the elderly, people who are overweight and people who already have heart,

chest or other medical conditions such as diabetes or kidney failure.  As with all surgery,

there is a risk you may die.

You will be cared for by a skilled team of doctors, nurses and other healthcare workers

who are involved in this type of surgery every day. If problems arise, we will be able to

assess them and deal with them appropriately.

Other procedures that are available

The present recommendation by the breast team health professionals is that in your

case surgery is indicated at this stage. An alternative procedure is a Vacuum Assisted

Biopsy (VAB) done under local anaesthetic. If you wish to discuss why this option was

not suitable for you, please speak to your breast consultant.

Your pre-operative assessment

Before you are admitted for your operation, you may be required to attend for a pre

operative assessment, to ensure that you are fit for surgery. It is important that you

attend for this appointment to avoid delaying your surgery.

Not all patients require a detailed pre-operative assessment and a health questionnaire

is used to determine which patients require a full assessment. The health questionnaire

may be on paper or on a tablet/computer. The information required includes all medical

conditions, regular medications, allergies to medications and your previous anaesthetic

history. The information you give will be reviewed by the pre-operative assessment

team. If you require further assessment, you will be given an appointment to attend the

pre-operative assessment clinic.

At the clinic, the nursing staff will confirm the medical information you have previously

given. Further tests may be required, such as a blood test, X-ray, heart or lung test. If a

more detailed assessment or discussion is required, you may see an anaesthetist prior

to your admission for surgery. This may require an additional appointment.

If you are taking prescribed medicines, please bring a copy of your repeat prescription

to your appointment and a copy of the operation consent form (if you were provided with

a copy at your out-patient appointment).

Following your assessment, the staff will provide you with written information regarding

preparation for your surgery and a point of contact. It is important that you follow the

fasting instructions given on your admission letter.

Being admitted to the ward

You will usually be admitted on the day of your surgery. We will welcome you to the

ward and check your details. We will fasten an armband containing your hospital

information to your wrist.

To reduce your risk of blood clots in your legs after surgery, we will usually ask you to

wear support stockings before and after your surgery and we will usually give you

heparin injections after your surgery. We will usually ask you to continue with your

normal medication during your stay in hospital, so please bring it with you.

Your anaesthetic

We will usually carry out your surgery under general anaesthesia. This means that you

will be asleep during your operation and you will feel nothing.

Before you come into hospital

There are some things you can do to prepare yourself for your operation and reduce the

chance of difficulties with the anaesthetic.

• If you smoke, consider giving up for several weeks before the operation.  Smoking

reduces the amount of oxygen in your blood and increases the risks of breathing

 problems during and after an operation. Using a vaporiser instead of smoking    may help the lung and breathing issues but does not significantly reduce the risk of post-operative wound problems.

• If you are overweight, many of the risks of anaesthesia are increased. Reducing

your weight will help.

• If you have loose or broken teeth or crowns that are not secure, you may want to

          visit your dentist for treatment. The anaesthetist will usually want to put a tube in

your throat to help you breathe. If your teeth are not secure, they may be          damaged.

• If you become unwell or develop a cough or cold the week before your surgery,

          please contact the pre-operative assessment team on the number provided.

Depending on your illness and how urgent your surgery is, we may need to delay

your operation as it may be better for you to recover from this illness before your

surgery.

Your pre-surgery visit by the anaesthetist

After your admission to hospital, the anaesthetist will come to see you and ask you questions about:

o your general health and fitness;

o any serious illnesses you have had;

o any problems with previous anaesthetics;

o medicines you are taking;

o allergies you have;

o chest pain;

o shortness of breath;

o heartburn;

o problems with moving your neck or opening your mouth; and

o any loose teeth, caps, crowns or bridges.

Your anaesthetist will discuss with you the different methods of anaesthesia they

can use. After talking about the benefits, risks and your preferences, you can then

decide together what is best for you.

On the day of your operation

Nothing to eat and drink (nil by mouth)

It is important that you follow the instructions we give you about eating and drinking.  We

will ask you not to eat or drink anything for six hours before your operation. This is

because any food or liquid in your stomach could come up into the back of your throat

and go into your lungs while you are being anaesthetised. You may take a few sips of

plain water up to two hours before your operation so you can take any medication

tablets. Please refrain from chewing gum.

Your normal medicines

Continue to take your normal medicines up to and including the day of your surgery.  If

we do not want you to take your normal medication, your surgeon or anaesthetist will

explain what you should do. It is important to let us know if you are taking anticoagulant

(blood thinning) drugs.

Your anaesthetic

When it is time for your operation, a member of staff will take you from the ward to the

operating theatre. They will take you into the anaesthetic room and the anaesthetist will

get you ready for your anaesthetic.

To monitor you during your operation, your anaesthetist will attach you to a machine to

watch your heart, your blood pressure and the oxygen level in your blood.

General anaesthetic

General anaesthesia usually starts with an injection of medicine into a vein. A thin plastic

tube (cannula) will be placed in a vein in your arm or hand and the medicines will be

injected through the tube. Sometimes you will be asked to breathe a mixture of gases

and oxygen through a mask to give the same effect.

Pain relief after surgery

Pain relief is important to aid your recovery from surgery. This may be in the form of

tablets, suppositories or injections. Once you are comfortable and have recovered safely

from your anaesthetic, we will take you back to the ward. The ward staff will continue to

monitor you and assess your pain relief. It is important that you report any pain you have

as soon as you experience it.

What are the risks?

The risk to you as an individual will depend on whether you have any other illness,

personal factors, such as smoking or being overweight and surgery that is complicated

or prolonged.

General anaesthesia is safer than it has ever been.  If you are normally fit and well, your

risk of dying from any cause while under anaesthetic is less than one in 250,000. The

side effects of having a general anaesthetic include drowsiness, nausea (feeling sick),

muscle pain, sore throat and headache. There is also a small risk of dental damage.

Your anaesthetist will discuss the risks with you and will be happy to answer any

questions you may have.

After your surgery

• You will be taken to the recovery room to the general or day care ward. You will

need to rest until the effects of the anaesthetic have worn off. You will have a drip

in your arm to keep you well-hydrated.

• You will be encouraged to get out of bed and move around as soon as possible,

as this helps prevent chest infections and blood clots.

• Your surgical team will assess your progress and answer any questions you have

about the operation.

Leaving hospital

Length of stay

How long you will be in hospital varies from patient to patient and depends on how

quickly you recover from the operation and the anaesthetic. Most patients having this

type of breast surgery will be able to go home the same day or the following morning.

Medication when you leave hospital

Before you leave hospital, the pharmacy will give you any extra medication that you

need to take when you are at home.

Recovery

How long it takes for you to fully recover from your surgery varies from person to person.

It may take 2 to 3 weeks.

Stitches

Your wound will be closed with dissolvable stitches, surgical glue and/or steristrips

(paper stitches).  Please keep your wound dry for the first 48 hours.

Personal hygiene

After 48 hours you may bathe and shower as normal but try not to soak the dressing.

Exercise

Try to go for a daily walk and check with your surgeon or breast care nurse before doing

more strenuous exercise. 

Sex

You can continue sexual activity as soon as you feel comfortable.

Driving

You should not drive until you feel confident that you could perform an emergency stop

without discomfort. It is your responsibility to check with your insurance company

regarding your insurance cover after an operation. You do not need to notify the DVLA

of surgical recovery unless it is likely to affect driving and persist for more than 3 months.

Work

How long you will need to be away from work varies depending on:

o how quickly you recover

o how your wounds heal

o whether you need further surgery or other treatments

o whether or not your work is physical

You can usually begin gentle work within a week or two, but you might need to wait a

little longer before resuming more vigorous activity. If you need a medical sick (FIT) note

for work for the first two weeks after your surgery, please ask the nurses on the ward

prior to being discharged.

Outpatient appointment

Before you are discharged we will either give you a follow-up appointment to come to

the outpatient department or we will send it to you in the post.

Contact details

If you have any specific concerns that you feel have not been answered and need

explaining, please contact the following.

Worcestershire Breast Unit 

Telephone – 01905 760261 

Email – [email protected]

If your symptoms or condition worsens, or if you are concerned about anything, please call your GP, 111, or 999.

Patient Experience

We know that being admitted to hospital can be a difficult and unsettling time for you and your loved ones. If you have any questions or concerns, please do speak with a member of staff on the ward or in the relevant department who will do their best to answer your questions and reassure you. 

Feedback

Feedback is really important and useful to us – it can tell us where we are working well and where improvements can be made. There are lots of ways you can share your experience with us including completing our Friends and Family Test – cards are available and can be posted on all wards, departments and clinics at our hospitals. We value your comments and feedback and thank you for taking the time to share this with us.

Patient Advice and Liaison Service (PALS)

If you have any concerns or questions about your care, we advise you to talk with the nurse in charge or the department manager in the first instance as they are best placed to answer any questions or resolve concerns quickly. If the relevant member of staff is unable to help resolve your concern, you can contact the PALS Team. We offer informal help, advice or support about any aspect of hospital services & experiences.

Our PALS team will liaise with the various departments in our hospitals on your behalf, if you feel unable to do so, to resolve your problems and where appropriate refer to outside help.

If you are still unhappy you can contact the Complaints Department, who can investigate your concerns. You can make a complaint orally, electronically or in writing and we can advise and guide you through the complaints procedure.

How to contact PALS:

Telephone Patient Services: 0300 123 1732 or via email at: [email protected]

Opening times:

The PALS telephone lines are open Monday to Friday from 8.30am to 4.00pm. Please be aware that you may need to leave a voicemail message, but we aim to return your call within one working day.

If you are unable to understand this leaflet, please communicate with a member of staff.

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