Dr. Zahraa Alhilli, MD, MBA

Fine needle aspiration (FNA) and core needle biopsy (CNB) are sometimes image-guided, where a mammogram, ultrasound, or MRI helps direct the physician performing the needle extraction.

Fine needle aspiration, the most common biopsy method, generally requires few patient preparations. It is recommended patients avoid using lotion, deodorant, and perfume prior to their biopsy procedure. FNA biopsy is performed with local anesthesia (topical numbing cream) and typically has a quick recovery, but patients may experience soreness for a few days. Core needle biopsy extracts slightly more tissue than an FNA biopsy.

Open (surgical) biopsy is more invasive and requires general anesthesia, where patients are put to sleep during the procedure. Patients must fast prior to the surgery. After the biopsy is performed, patients are monitored in a recovery room for a time before being discharged, when they will need someone else to provide transportation.

Although some may consider breast biopsy to be a simple procedure, it can catch critical issues - particularly breast cancer - that impact wellness. If a breast biopsy reveals an underlying condition like life-threatening cancer, patients can receive the diagnosis and medical treatment that is necessary for their long-term health.

• Two or more cancerous regions in the same breast
• Inability to receive chemotherapy or radiation therapy
• High likelihood of recurring breast cancer
• Large tumor that is bigger than two inches across
• Pregnancy that prohibits radiation therapy
• Preexisting conditions like lupus or scleroderma

Notably, some patients may elect to undergo mastectomy without a breast cancer diagnosis. Preventative (prophylactic) mastectomy is performed on those with a high risk of breast cancer, such as having a family history of the disease or carrying the breast cancer BRCA1 or BRCA2 gene. Preventative mastectomy substantially reduces one's chances of developing breast cancer in the future, but it cannot wholly prevent it.

Surgical oncologists perform several types of mastectomies, depending upon the severity of the breast cancer (including factors such as its location and spread), as well as the patients' own aesthetic and personal choices. The six main types of mastectomy include:

• Total mastectomy, where the surgical oncologist removes an entire breast, including parts like the pectoral chest muscle, skin, and nipple.
• Radical mastectomy, where the surgical oncologist removes the entire breast, underarm lymph nodes, pectoral chest muscles, and outer skin and nipple. One of the most invasive forms of mastectomy, radical mastectomy is infrequently performed.
• Modified radical mastectomy, where the surgical oncologist completes a total mastectomy and also removes the underarm lymph nodes. This procedure is slightly less invasive than radical mastectomy.
• Skin-sparing mastectomy, where the surgical oncologist removes cancerous breast tissue and nipple, but leaves most of breast skin. This method is used in conjunction with breast reconstruction, as implants can be added below the skin. Skin-sparing mastectomy often requires a treatment team with a surgical oncologist and a plastic surgeon experienced in breast procedures.
• Nipple-sparing mastectomy, where the surgical oncologist removes cancerous breast tissue and leaves the nipple and most of the breast skin. This method is only available to patients in the early stages of breast cancer. Similar to skin-sparing mastectomy, this procedure is frequently performed with breast reconstruction.

Any of these procedures can be done on both breasts, in which case the procedure would be known as a double mastectomy. For example, a surgical oncologist might perform a total or nipple-sparing mastectomy on both breasts. Double mastectomies are often used as a preventive surgery for those who are at risk of developing breast cancer later on in life.

Patients have one or two days of hospital stay before returning home from their mastectomy procedures. Full recovery can take several months, but some patients find they are able to resume normal activity within one month of their mastectomy. Patients are advised to limit arm and chest movements whenever possible.

After surgery, patients must also adjust to changes in their appearance. While some patients choose to receive breast reconstruction, other patients may decide to wear prosthetic breasts or will simply embrace their new chest.

Mastectomies permit patients to conquer cancer and lead healthy, thriving lives as breast cancer survivors.