Breast Surgery | Lumpectomy | Excisional Biopsy | Mineola

Incisional Biopsy - Excisional Biopsy - Mammary Duct Excision - Lumpectomy - Sentinel Lymph Node Biopsy - Axillary Lymph Node Dissection - Modified Radical Mastectomy - MammoSite Catheter Placement for Brachytherapy

Incisional Biopsy

A breast biopsy is performed to remove a sample of tissue from a solid mass to determine whether it is malignant (cancerous) or benign (non-cancerous). One type of biopsy is an open biopsy, where the surgeon makes a one- to two-inch incision in the breast under local anesthesia and sedation in order to remove some or all of the tissue under scrutiny. In an incisional biopsy, only part of the mass is removed for examination. The surgeon then closes the incision and covers it with a bandage.

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Excisional Biopsy

An excisional biopsy is another type of open biopsy where the entire lump is removed rather than only a part of it. Excisional biopsies are usually performed when the lump is small.

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Mammary Duct Excision

Most breast cancers begin in the mammary ducts, and a common symptom of breast cancer is nipple discharge. Excision (removal) of one or both mammary ducts and subsequent examination in a lab is typically the only way to determine whether the discharge is benign or being caused by invasive or non-invasive cancer, papilloma, ductal hyperplasia, duct ectasia or another problem. Mammary duct excision may be performed during or after a ductoscopy (visualization) or biopsy.

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Also called a wide excision biopsy, a breast-conserving lumpectomy extracts an entire cancerous lump from the breast along with a thin margin of healthy tissue surrounding it. This ensures that all traces of malignant tissue are removed. Lumpectomy is typically recommended in place of mastectomy for women whose cancers are small and/or localized. Lumpectomy may be followed up with a lymph node biopsy or radiation therapy.

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Sentinel Lymph Node Biopsy

The sentinel lymph node under the arm is the first node that drains fluid from the breasts. Because of its position, many doctors believe that:

  • If cancer spreads beyond the breast, the sentinel node is the first place those malignant cells would appear; and
  • If there are no cancerous cells in the sentinel node, the cancer has likely not spread beyond the breast.

Biopsy of the sentinel lymph node to look for cancerous cells can be done under local anesthesia at the same time as a breast biopsy or lumpectomy. First, the surgeon injects a dye or radioactive tracer into the breast tumor. He then tracks the dye as it travels to the sentinel node. Once located, the node can be removed through a small incision and examined.

If results come back positive, biopsy of the next lymph nodes in line—the axillary nodes, also under the arms—may be recommended. If results are negative, no further action is necessary.

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Axillary Lymph Node Dissection

Like a sentinel lymph node biopsy, examination of the axillary lymph nodes under the arms can reveal whether cancer has spread beyond the breast to other parts of the body. Axillary lymph node dissection may be performed at the same time as a breast or sentinel node biopsy, after a breast or sentinel node biopsy has produced positive results, or during a mastectomy. Under general anesthesia, the surgeon makes an incision under the arm, removes a small amount of fat containing a cluster of lymph nodes, and closes the incision with sutures.

Axillary lymph node dissection is a more invasive procedure than a sentinel node biopsy and can result in side effects such as lymphedema (swelling) in the arm, limited arm or shoulder movement and numbness on the skin of the upper arm.

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Modified Radical Mastectomy

The most common type of mastectomy performed today, modified radical mastectomy involves the surgical removal of the breast, nipple/areola, lining over the chest muscles, and some or all of the axillary lymph nodes. Sometimes, part of the chest wall muscle will also be removed. Modified radical mastectomy ensures that the original cancerous tumor in the breast has been excised as well as the breast and lymph tissue malignant cells may have spread to. It also reduces the risk of cancer recurrence in the breast. Performed in a hospital under general anesthesia, modified radical mastectomy involves incisions in the breast and under the arm. Breast reconstruction is possible for most patients during the same operation that removes the breast.

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MammoSite Catheter Placement for Brachytherapy

Radiation therapy is often recommended after breast-conserving cancer surgery such as lumpectomy to ensure that all traces of malignant tissue have been eradicated. MammoSite brachytherapy allows radiation to be delivered within the breast directly to the area where the tumor was removed, rather than requiring the entire breast to be exposed to external radiation. A radioactive seed is delivered to the area through a catheter, which can be placed in the breast during the lumpectomy or afterwards in the same location as the original incision so as not to create a second scar.

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Incisional Biopsy - Excisional Biopsy - Mammary Duct Excision - Lumpectomy - Sentinel Lymph Node Biopsy - Axillary Lymph Node Dissection - Modified Radical Mastectomy - MammoSite Catheter Placement for Brachytherapy

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