Vacuum Assisted Biopsy (VAB) and Vacuum Assisted Excision (VAE) of the Breast

The doctor has recommended that you have either a vacuum assisted biopsy (VAB) or a vacuum assisted excision (VAE) of the breast. Both procedures, although they have different names, are essentially the same. They are done to give us more information about changes in the breast that have been found either on your mammogram (breast x-ray) or breast ultrasound. The majority of changes are benign (innocent) and present no health risk to the patient, but it is important that we find out exactly what the cause of the change is in your case.

The VAB/VAE is a simple and quick method of taking samples of breast tissue which can be sent to the Pathology department to be examined under a microscope and provide your doctor with a diagnosis. There is usually no special preparation needed before having a VAB or VAE, but you must let staff know if you are taking a blood thinning medication, for example warfarin,  clopidogrel or aspirin. In these circumstances you will be advised by the doctor of the correct preparation before you are given an appointment for this procedure.

The VAB/VAE can be carried out with the help of either x-rays or ultrasound depending on the type and position of the area of interest in your breast. The doctor will discuss this with you to decide the best method in your case and you will be asked to sign a consent form for the procedure.

X-ray-guided VAB/VAE:

This is sometimes called a “stereotactic” or “stereo” biopsy. It will be carried out by either a Breast Radiologist, a doctor who specialises in x-rays/ultrasound, or an Advanced Radiographic Practitioner, a radiographer who has been specially trained in breast biopsies.  Depending on the area of the breast the sample is to be taken from, you will either lie on a couch or sit up and your breast will be positioned in the x-ray/mammogram machine.

Your breast will be compressed as it was for your mammogram examination, and the staff will take x-rays to check you are in the right position. When you are in the correct position, two x-rays will be taken at different angles. These are called “stereo images” and are used with the computer to find the exact position for the biopsy needle.

You will be given an injection of local anaesthetic to numb the area to be biopsied. This may sting initially but after that you should not feel any pain. A tiny cut (approximately 5 mm) will be made in the skin to allow the samples to be taken. You will feel some pressure on your breast as the biopsy is taken and staff will check regularly that you are comfortable.

Most patients find lying on the couch quite comfortable, but you must let staff know if you have any problems with the position so that they can make adjustments to help you.

The procedure uses a gentle vacuum system to remove the samples and you will be able to hear a noise a bit like a sewing machine while the samples are taken.

A tiny metallic marker, typically made of titanium, is usually placed in the breast to mark the area where the biopsy was taken. The staff will inform you if this is going to happen. You will not be able to feel the marker and it will not affect you in any way in the future.

Ultrasound-guided VAB/VAE:  

If you are having this procedure it will be carried out by a breast radiologist or specialist radiographer and you will be asked to lie on your back or your side on an examination couch. Your breast will be examined using the ultrasound machine to pinpoint the area that will be biopsied. You will be given an injection of local anaesthetic to numb the area and a tiny cut (approximately 5 mm) will be made in the skin to allow the samples to be taken. The vacuum assisted biopsy machine will then be used to remove some samples of breast tissue. As mentioned above, you will be able to hear a noise a bit like a sewing machine while the samples are taken, and afterwards a tiny metallic marker is usually placed in the breast to mark the area where the biopsy was taken, which you will not be able to feel and will not affect you in any way in the future.

What will happen after my procedure?

This is a straightforward procedure and the risks/complications are usually minor. The most common is experiencing some bleeding and bruising. When the test is finished the nurse will apply pressure to the biopsy site for around five to ten minutes to reduce bleeding and bruising. They will apply some paper stitches over the tiny skin cut as well as a dressing. You will be asked to get dressed and sit in the waiting area for a further ten minutes with a drink to ensure you feel well and there is no further bleeding before you go home.

Most patients feel fine after the procedure and are able to resume light activities. However, we would recommend that you avoid strenuous exercise for at least 24 hours following the biopsy to help minimise bruising. If possible it is best to go home and put your feet up and relax for at least a few hours after the procedure.

Over the next few days, you will probably have some bruising on your breast in the area the biopsy was taken from, and sometimes a small lump may be noticeable under the skin. This is extremely common and is nothing to be concerned about. Sometimes it can take over a week to settle fully. However, if the area becomes red or inflamed or you are concerned please contact the department on the number provided in this leaflet.

You may bathe or shower as usual and can remove the dressing after 24 hours. The paper stitches should be left on for approximately three days after which you may find it easiest to soak them off in the bath or shower.

If you feel any discomfort after the biopsy you can take paracetamol unless you have a known allergy to this medication. Wearing a firm supportive bra may also help.

We generally recommend that you do not take aspirin to relieve discomfort as this can cause more bleeding and bruising. However if you take aspirin as part of a prescription for another medical condition then you may continue it as normal.

How will I get my results?

This will depend on how you were referred for your breast biopsy.

You may be given an appointment before you leave the hospital to return to the breast clinic for your results or you may have an appointment given to you in the post or by telephone to see your consultant for the results.

Please feel free to ask staff if you have any concerns about how you will receive the results of your biopsy.

Occasionally the tissue sample does not provide a complete diagnosis. For example, it may not contain any of the tissue that the doctor wants to look at, there may not be enough breast tissue to test, or the results of the laboratory tests may be uncertain.

If this is the case the doctor will discuss the options available to you.

What alternative procedures are available?

Possible alternatives to VAB/VAE are:

Core needle breast biopsy: this is a similar procedure to a VAB/VAE but a smaller piece of tissue is removed, which may not be large enough for the laboratory to examine fully. You may have already had one of these before your VAB/VAE.

Diagnostic open surgical biopsy: this is performed in the operating theatre by surgeon under general anaesthetic and would result in more significant scarring of the breast and a short stay in hospital.

Your doctor will discuss with you which procedure is best for you.

Further information

If you have questions that are not addressed in this leaflet please contact Gateshead Breast Screening Unit, where staff will be happy to help you.

0191 445 3747 Monday to Friday 9 am to 5 pm

Out of hours please contact NHS 111

If you wish to give any feedback please contact the Superintendent Radiographer on 0191 445 3775