Definition

MIBB is a breast biopsy that is done with a needle to obtain a diagnosis of a breast abnormality.  There are three different types of MIBB, described below.  MIBB is considered by most to be the quickest, safest, least invasive way to obtain a diagnosis for your breast abnormality, though it is not 100% perfect.

Sometimes for quicker scheduling or equipment availability, after your initial consultation in the office, I might ask the interventional breast radiologist to perform your procedure.  In this case, be assured that I will interpret your pathology results, correlate them to your imaging to ensure accuracy, and formulate a plan.  I will always remain in charge of your follow up care and should you have any questions, please call the office.

Risks of Procedure

With every procedure, there are small risks.  The biggest risks of MIBB include bruising, bleeding, wound infection, scarring, and chronic pain.  There is also a small risk of non-diagnosis (not enough tissue for the pathologists to ensure what is going on, often requiring a repeat biopsy) or misdiagnosis (false negative, also known as mammographic-pathologic discordance).  The risk of non-diagnosis and misdiagnosis are incredibly low, but this is why follow up is so important, and I will let you know if I am concerned about either of these possibilities.

Types of MIBB

  • Stereotactic Breast Biopsy:  A type of MIBB that is done with a mammogram to biopsy either calcifications within a breast or a mass.  This is performed at the Women’s Health Center by either myself or a breast-specific interventional radiologist.
  • Ultrasound (US)-guided Breast Biopsy:   A type of MIBB that is done with an US to biopsy a cyst or mass.  This is performed typically at the Women’s Health Center by a breast-specific interventional radiologist, or sometimes in my office.
  • MRI-guided Breast Biopsy:  A type of MIBB that is done at the Imaging Center at Mount Carmel East.  This is performed by the MRI-specific interventional radiologist. This type of biopsy is typically done for the very rare breast abnormality that is only visualized on MRI, and not on seen on either mammogram or US.

What to Expect

On the day of the procedure, you do not need to fast; with the exception of blood thinners and platelet agents (for example, asprin, Plavix, Coumadin, Pradaxa, and Xarelto), it is okay to take your regular medications.  If you are on a medication that affects bleeding, make sure you have stopped the medication in the appropriate time frame, described by me or my scheduler during the office consultation.

You will be checked in appropriately, and the typical length of visit (check in, procedure time, and check out) is about 1-1.5 hours, so plan accordingly.  You may drive yourself home after the procedure, as the anesthetic used is just a local, but I encourage someone to accompany you in case you have just a little extra discomfort.

Description of Procedures

Mammogram biopsies are performed on a “stereotactic table”.  You will lie on your abdomen, and your breast will dangle through a hole in the table.  I will then use several views of the mammogram to localize the area that needs biopsied.  After this area is located, a local anesthetic will be placed at the area, which stings a bit.  A small 2mm incision is then made at the site, and the needle is placed.  Several more mammograms confirm good positioning of the needle, and then the biopsy is taken.  This biopsy takes just a few minutes.  Several cores of tissue are removed, and then sometimes an xray of the tissue is taken.  Once the biopsy is complete, a non-reactive clip is placed within the breast.  The clip will stay within the breast to signify location of biopsy for future imaging follow up.  You will not set off alerts at the airport with this marker.  After the clip is placed, the needle is removed and a light pressure will be held at the breast to stop any light bleeding.  A steri strip (butterfly bandage) is placed to close up the small needle hole.

Ultrasound and MRI biopsies are performed in similar manners.  The ultrasound biopsy is done slightly different from the mammogram biopsy in that you lie on your back, and not your abdomen.  Ultrasound is used instead of mammogram, but the technique is otherwise the same as described above.  MRI guided biopsies are also done lying on your abdomen, and the technique is the same as with mammogram biopsies.

What to Expect After the Procedure

Most people have a slight ache or tenderness within the breast for 48-72 hours afterwards, so strenuous activity (running, heavy lifting) should be avoided.  If you have discomfort, it is okay to take Tylenol, Ibuprofen, or Alleve, and use ice packs as necessary.  Some bruising is entirely normal, and a small number of women may develop a hematoma (collection of blood) within the breast after the procedure.  This is not harmful, and with time, your body will reabsorb all this blood and your breast will return to normal, though this may take several weeks.

Post-Procedure Instructions and Follow-Up

It is ok to shower and get your incision wet in 24 hours, though swimming or baths should be avoided for 1-2 weeks.  Just pat the area dry after showering.  Pathology results are variable, and average 1-3 days, but do not worry if your pathology takes longer.  Our pathology department maintains the highest quality standards, and this ensures our patients an accurate diagnosis.  In most cases, if your pathology is benign (non-cancerous), you will need repeat imaging in 6 months to serve as your new baseline exam.  As always, you are entitled to your pathology report, so if I forget to offer it to you, please ask.  I will also send your referring physician (and primary care doctor) your pathology results.

Kristine Slam, MD, FACS
Director of Cancer Services, Mount Carmel East Hospital
Medical Director, Mount Carmel Cancer Risk ProgramQuality Director, Mount Carmel Breast Program