Image-Guided Vacuum Assisted Biopsy or Vacuum Assisted Excision Aftercare Advice

Introduction

The breast care team has advised that you should have a further procedure. Depending on your personal circumstances this will either be a vacuum assisted biopsy or a vacuum assisted excision.

What is a Vacuum-Assisted Biopsy (VAB)?

This procedure is used when the histopathologists (person who looks at tissue under a microscope) have requested more tissue to enable them to reach a diagnosis.  Only a small amount of extra tissue is removed.

What is a Vacuum-Assisted Excision (VAE)?

This procedure is used to remove benign (none harmful) lesions (abnormal tissue) and lesions that although non-cancerous have been reported by the histopathologists as having some abnormal features. A VAE usually removes more tissue than a VAB and replaces the need for a general anaesthetic. A VAE should be regarded as a minor surgical procedure under local anaesthesia.

In both cases, a local anaesthetic is given and, under image guidance, a hollow needle inserted into the breast. A vacuum is then used to ‘suck out’ the targeted lesion.

Image Guidance

You will have already had a mammogram and/or an ultrasound examination. Your vacuum-assisted procedure will be guided by whichever gave the best image of the lesion to be sampled/removed.

Who will do my biopsy?

A member of the breast radiology team who specialises in vacuum-assisted procedures and other similar types of examination will carry out the procedure.

What to do before your Vacuum-Assisted Procedure

When you get your appointment please let us know if you are taking any medication which affects how your blood clots. For example if you are taking:

• Warfarin, Rivaroxaban, Apixaban, or Clopidogrel. We will tell you if you need to stop taking them and when.
• Tinzaparin and Dabigatran should be stopped the day before your procedure and started again the day after.
• Aspirin should be stopped 5 days before the procedure.

What are the risks and possible complications?

The most common risks and possible complications include:

• Pain. You may feel some discomfort during the procedure however this should only be minimal and more local anaesthesia can be given if you experience acute discomfort.

After the procedure any localised discomfort should wear off within 24 hours. You may take painkillers for example paracetamol or ibuprofen.

• Bleeding. Following the procedure, pressure will be put on the area where the tissue was removed and a localised dressing applied once the bleeding has stopped.

• Trembling. Following the procedure you may feel a bit shaky. This is due to the local anaesthesia used. It has adrenaline in it to help prevent excess bleeding and bruising. It is the same anaesthetic that dentists use. The shaking/trembling will pass within half an hour. Please do not drive until this after affect has stopped.

• Bruising. There may be some localised bruising and swelling. This should disappear in 48 hours. We advise you to rest when you get home and apply gentle pressure to the area. Wearing a soft sports bra or similar, continuously for 48 hours, will help with any discomfort or swelling.

• Transfusion. In very rare cases, less than 1 in 10,000, a blood transfusion may become necessary if bleeding persists at home and is ignored.

What happens to the cavity?

A small cavity will be formed by the removal of the tissue. After the procedure this may fill with blood and a blood clot form. The clot can take a long time to go away, up to 6 months.

Alternatively, a little bleeding occurs and the cavity could be felt (palpable) for up to 6 months. In both cases the internal scarring to the breast will resolve.

Caring for my wound

There will be a small wound (hole) where the needle entered the breast. This will be closed with Steri-Strips (special paper stitches) and covered with a small dressing. Please inform the staff if you are allergic to any types of sticking plaster.

It is important that you keep the dressing dry for 24 hours so avoid showering.  After 24 to 48 hours you can remove the dressing. This may be easier to do if it is first soaked in the bath or shower.

What should I do when I get home?

You should:

• Relax quietly at home for the rest the day, eat and drink as normal.
• Take any medication as normal unless your doctor has advised you not to.
• Do not lift any heavy objects for 24 hours.
• Do not play contact sports, for example football or judo for 48 hours after your procedure.

What to watch out for

If any of the following symptoms persist or develop you should contact the Breast Care Nursing Team (see contact numbers) or come into Accident & Emergency (A&E).

Attend A&E if you experience any of the following:

• Heavy bleeding, if after placing a clean dry cloth over your wound and pressing firmly for 10 minutes the bleeding continues and the breast continues to swell.
• If the area around your biopsy becomes more swollen and the breast tightens.
• If you feel feverish, unwell or develop a temperature higher than 38°C, (100.4°F).
• If your discomfort increases and you experience a chest pain or shortness of breath.

When can I return to normal activities/work?

You should be able to drive within half an hour of the procedure finishing.

We advise you to avoid any strenuous exercise or heavy lifting for 48 hours after the procedure.

Returning to work will depend on the type of work you do. If it involves heavy lifting or the danger of the breast being knocked it is advised to delay for 48 hours.

When will I get my results?

How you get your results will be discussed at the time of your appointment.

The tissue taken will be sent for testing and this can take some time due to the volume of tissue removed. The results are usually available within 2 weeks. You may have already been given an appointment or you will receive a letter. Your GP will also receive a letter.

Contact numbers:

University Hospital in North Tees

Breast Care Nursing Team

Telephone: 01642 624371

Monday to Friday, 9am to 5pm

University Hospital of Hartlepool

Breast Care Nursing Team

Telephone: 01429 522387

Monday to Friday, 9am to 5pm

NHS choices

Telephone: 111 (when it is less urgent than 999)

Calls to this number are free from land lines and mobile phones or via the website at 111.nhs.uk

Comments, concerns, compliments or complaints

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Telephone: 01642 624719
Freephone: 0800 092 0084
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Telephone: 01642 617617

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