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All TopicsForum: Surgery - Before, During, and After → Topic: How Much Tissue Do They Take Out in Open Surgical Biopsy?

Topic: How Much Tissue Do They Take Out in Open Surgical Biopsy?

Forum: Surgery - Before, During, and After — Surgical options and helpful tips for recovery and side effects.

Posted on: Feb 23, 2013 06:28PM

LesIsMore wrote:

I had calicifications on my mammo so I went for stereotactic breast biopsy. It showed ADH. I referred to a general sugeron for an open surgical biopsy. The surgeon said the tissue removed would be about the size of an apricot or a peach! Wow, that really surprised me that so much tissue would be removed for ADH in one area (single focal, microscopic lesion in the duct, no lump). I then measured and that could be 30mm (3cm) for an apricot and 50mm or more for a peach. I have large breasts (38DD or larger) and that would be at least a quarter to a third of my breast in the inner, upper, right quadrant.

I calculated that my lesion is less than 5mm and if you wanted margins of 10mm of more than we're talking about 25mm (2.5cm) or smaller than an apricot. 

My questions are:

Are there any standards for the amount of tissue that should be removed in an open surgerical biopsy? (margins beyond size of lesion)

What size of tissue did they remove on your open surgery? (in mm, cm, or inches)

What was the amount of margin around your lesion?

Was your breast deformed afterward?

What was the general shape of the mass removed? A sphere/ball? An oval? 

I'm not that attached to my breasts, if they have to go, then they have to go. However, it just seems like a big operation for a potentially benign outcome (85% are benign). My surgeon seem to indicate that she'll know when she's in there, but that doesn't make sense to me because she'll be flying blind mostly because the area in not visible and will be identified by the needle/wire placed in my breast prior to the surgery by using mammography. It seems to me that we now have over a dozen mammo slides to determine the exact place of the lesion (which has mostly or completely removed during the streeotactic/core biopsy). We should be able to determine the appropriate margin before going in. I realize that it may be off by a little bit--a few mm here and there, but not by a huge amount).

So, ladies, can you give me any guidance here? What would be a reasonable amount of tissue to remove in this biopsy?

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Posts 1 - 7 (7 total)

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Feb 23, 2013 06:49PM Annette47 wrote:

I have no idea what is "standard" but am happy to share my experience for comparison -

They removed an area 7x7.5x3 (this is in cm).   The smallest margin was 1 cm, the others bigger but I don't know how much.   It was a small lesion, but she also wanted to be sure and remove the biopsy track.

At first yes, and still a little bit (mostly because there is still fluid and some swelling rather than because it is obvious anything is missing) but it is still healing and changing.  I think when it is all done it will be fine though.   Maybe a tiny bit smaller than before, but that side was a bit bigger anyway.  I don't anticipate any major deformity.    My BS says that the tissue will "rearrange" itself for 6 months to a year before settling into it's final shape and I can tell that there has been quite a bit of improvement just in the 2 months since the surgery.

I believe it was oval.

FWIW, mine started out as a small D/large C cup.

Dx 11/20/2012, IDC, <1cm, Stage Ia, Grade 2, 0/3 nodes, ER+/PR+Dx 11/20/2012, DCIS, <1cm, Stage 0, Grade 2, 0/3 nodes, ER+/PR+Hormonal Therapy TamoxifenSurgery 12/18/2012 Lumpectomy (Left); Lymph Node Removal: Sentinel Lymph Node Dissection (Left)Radiation Therapy 01/21/2013 External
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Feb 23, 2013 06:53PM, edited Feb 23, 2013 06:56PM by farmerlucy

I had two excisional biopsies. The first one was about the size of my index finger. It missed the offending duct and the ALH and ADH that would have been in there. Two years later I had another excisional biopsy and it took out a 4 cm by 6 cm by 2 cm piece. Quite a big bigger. Thank God the new surgeon took that much. He excised the correct duct and revealed the ALH, ADH.

My right breast was a little smaller after the biopsies, but only I would noticed. The area seemed to fill in in a short period of time and didn't seem too oddly shaped. For me NO DOUBT more was better!

Dx 2/24/2012, IDC, 1cm, Stage Ia, Grade 2, 0/1 nodes, ER+/PR+, HER2-Surgery 02/21/2012 Prophylactic Mastectomy (Both); Reconstruction: Tissue expander placement (Both)Surgery 03/11/2012 Lymph Node Removal: Sentinel Lymph Node Dissection (Right)Surgery 07/22/2012 Reconstruction: Breast implants (permanent) (Both)Hormonal Therapy 04/10/2013 Tamoxifen
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Feb 23, 2013 08:24PM lemon68 wrote:

My BS told me about the size of a golf ball. I was large C, small D. Its been almost 2 months, From the front looking on no change, from the side I see a small indent. My area was at 11:00 O clock.. still bruised and hard. Incision along nipple, cannot see it unless I point it out and how often do you point your nipple out to someone :)

You will be okay. Trust your BS to answer all your questions honestly until you are satisfied, if not find another BS.

Best wishes to you.

Don't compromise yourself. You are all you've got. There is no yesterday, no tomorrow, it's all the same .... day.

Dx 1/4/2013, ILC, <1cm, Stage Ia, Grade 2, 0/2 nodes, ER+/PR+, HER2-Surgery 12/31/2012 Lumpectomy (Right)Surgery 01/24/2013 Lymph Node Removal: Sentinel Lymph Node Dissection (Right)Radiation Therapy 03/18/2013 ExternalSurgery 09/19/2013 Prophylactic Ovary Removal (Both)Surgery 05/05/2014 Mastectomy (Both); Prophylactic Mastectomy (Left); Reconstruction: DIEP flap (Both)
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Feb 23, 2013 10:36PM MelissaDallas wrote:

Mine was the size of a golf ball. My lesion was at about 3:00 position & she went in through outer lower crease of my breast. When I raise my arm you can see a small indent but it is not very noticeable and I am not very big breasted.

You are referring to clean margins. That is not the aim with an excisional biopsy. They really only talk about getting sufficient (clean)margins when you have a lumpectomy, which is performed post confirmation of a a cancer diagnosis. The size of what is removed just depends of the area of concern in your mammogram, MRI or ultrasound.

LCIS, extensive sclerosing adenosis, TAH/BSO & partial omentectomy for mucinous borderline ovarian tumor.

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Feb 24, 2013 11:22AM Beesie wrote:

LesIsMore, I've had 3 excisional biopsies.  Each was different.  That's because there are no standards for something like this.  The surgeon has to evaluate the specifics of the individual case and go from there. Two different surgeons looking at the same case may choose to do it differently.

As MelissaDallas said, generally it's not the surgeon's goal with an excisional biopsy to achieve good margins. With ADH there is about an 80% chance that the patient does not have breast cancer, and most surgeons would agree with you that they don't want to do a big operation and remove too much breast tissue when the most likely result is that there is no cancer. So normally the surgeon will try to remove all the suspicious tissue, but not much more. In some cases, however, if someone is large breasted and the area of concern is small, the surgeon might make a judgement call that removing a bit more breast tissue won't impact the appearance of the breast and so he or she might take out more in an attempt to get good margins.  As for how much extra would be taken... again, that depends on the surgeon and the size of the breast. While 10mm is an ideal margin, 2mm is an acceptable margin; even when operating on a known cancer, many surgeons will not go for 10mm margins on women who are small breasted.

In my case, I'm small breasted and I had two areas of calcifications. The needle biopsy had found ADH in one area and wasn't able to reach the other areas. When I went for my excisional biopsy, my surgeon tried to remove all the suspicious tissue in both areas, without removing any excess breast tissue.  It was still a lot of breast tissue that came out. And as it turns out, I had DCIS in both areas and a microinvasion of IDC in one area, and no clean margins. With DCIS, it sometimes happens that not all the cancer shows on a mammogram, particularly for women who have extremely dense breasts, as I do. So you're right that the surgeon is operating blind; the calcifications are microscopic and impossible to see with the naked eye, and if there is cancer present, that too is impossible to see. And the other potential problem is that the imaging might not be fully accurate. This is why it's not uncommon to end up with 'dirty' margins after surgery, even when the surgeon is attempting to deliver good margins. 

So to net it all out, there are no standards to the size or shape of the what will be removed. It depends on the size and shape of the lesion, and to some extent, the size of your breast (since a surgeon will be more likely to attempt margins during an excisional biopsy if someone is large breasted). Whether or not your breast is deformed depends on how much is removed and how large your breast is; with an excisional biopsy usually surgeons will try to remove enough tissue but no more than necessary so the impact on the appearance of the breast is minimized. 

In your particular case, the good news is that with such a small area of calcs - only about 5mm - the likelihood of finding DCIS or IDC is probably lower than the 20% average - and in all likelihood not much breast tissue will need to be removed. So there's not much, if any, impact on the appearance of your breast.

Good luck with the surgery!

Dx 9/15/05, DCIS-MI, 6cm+ Gr3 DCIS w/IDC microinvasion, Stage I, 0/3 nodes, ER+/PR- “No power so effectually robs the mind of all its powers of acting and reasoning as fear.” Edmund Burke

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Feb 26, 2013 06:33PM ballet12 wrote:

Hi Lesismore,

I am small-breasted, and I have had six procedures on one breast (four excisional biopsies and then two re-excisions).  I didn't get a noticeable cosmetic defect until after the last re-excision.  Prior to that, there was a change in the size of the breast after, I would say, the third procedure.

I can't tell you the exact amount of tissue taken out in earlier procedures (going back several years), but I had at least 6 cm's taken out (total) in the last three, but two of those were done for clean margins.  I'm glad no one ever used that fruit analogy with me.  I wouldn't have been a happy camper!

Dx DCIS, 5cm, Stage 0, Grade 3, ER+/PR-Surgery 07/27/2012 Lumpectomy (Right)Surgery 10/05/2012 Lumpectomy (Right)Surgery 10/26/2012 Lumpectomy (Right)Radiation Therapy 01/10/2013 External
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Mar 4, 2013 08:05PM LesIsMore wrote:

Annette47,

Thank you so much for sharing your experience. My, I'm rather surprised it was that large of a biopsy. That was very helpful to know that the shape was different than I imagined (sounds like yours was a stack of three slightly oval hamburger patties). It's also great to know that your surgery went well and all is expected to rearrange itself after six or more months.

Wishing you the best. Thanks again for your help.

Leslie