Vacuum-assisted Breast Excision / Biopsy (VAB) Information

What is a vacuum-assisted breast biopsy?

A vacuum-assisted breast excision/biopsy (VAB) is a minimally invasive procedure used to take samples of breast tissue for further examination in a laboratory.

The area being investigated is located using breast imaging, mammography or ultrasound – the type of lesion determines what imaging is used.

A small biopsy needle is inserted into the breast through an opening in the skin. The needle is connected to a vacuum device, which gently draws tissue into the needle so that several samples can be taken or the area excised.

A small marker is placed at the biopsy site after the samples have been obtained. This allows the area to be identified on future imaging if required.

Why do I need a vacuum-assisted biopsy?

Your breast imaging has shown an area that requires further assessment. A vacuum-assisted biopsy allows a larger number of tissue samples to be obtained than with a standard core biopsy.

The procedure may be recommended for areas such as:

Microcalcifications seen on a mammogram
Small areas of abnormal breast tissue
Areas that are difficult to sample with a standard biopsy
Findings where a larger tissue sample is helpful for diagnosis

Before the procedure

You can usually eat and drink normally before your biopsy unless you have been given different instructions.

Do not wear deodorant, powder, or cream on your breast or underarm area.

Please tell the breast imaging team before your procedure if you:

are taking any blood-thinning medicines, as it may be necessary to stop these medications for a period of time prior to the procedure date
have any allergies, particularly to local anaesthetic or dressings
you are breastfeeding
you are pregnant

Do not stop taking prescribed medication unless you have been specifically instructed to do so by your healthcare professional.

A comfortable, supportive bra can be helpful to wear after the procedure.

What happens during the biopsy?

A member of the breast imaging team will explain the procedure and answer any questions you may have.

Local anaesthetic is used to numb the breast, so you should not feel significant pain.

You will be positioned so that the area of concern can be accurately identified using imaging. The skin will be cleaned with an antiseptic solution, and local anaesthetic will be injected to numb the area.

The device will collect several tissue samples, and a marker will be placed at the biopsy site.

Pressure will be applied to the area to reduce bleeding and bruising. A dressing will be placed over the biopsy site.

You may hear clicking or other sounds from the equipment during the procedure. You may feel some pressure or pulling, but you should tell the team if you experience significant discomfort.

The procedure itself usually takes approximately 60–90 minutes, although this can vary depending on the location and type of abnormality.

What are the possible risks?

Vacuum-assisted breast biopsy is generally a safe procedure, but as with any medical procedure, there are some risks.

These can include:

Bruising
Swelling
Tenderness or discomfort
Minor bleeding
Infection
A small amount of bleeding or fluid from the biopsy site
A small scar at the biopsy site
Occasionally, a collection of blood called a haematoma

Serious complications are uncommon.

If you are taking blood-thinning medication, your risk of bleeding may be increased. Your clinical team will advise you if any specific precautions are required.

After the procedure

You will normally be able to go home after the biopsy.

It is common for the breast to feel bruised or tender for a few days. You may notice some swelling or a small lump around the biopsy site.

A supportive bra may help reduce discomfort.

You may usually return to normal daily activities, but you should avoid strenuous exercise, heavy lifting and vigorous arm movements for 24–48 hours, or as advised by your healthcare professional.

Simple pain relief such as paracetamol may be taken if appropriate for you.

Looking after the biopsy site

Keep the dressing in place for the length of time advised.

A small amount of bruising or swelling is normal. Try not to press or massage the biopsy site unnecessarily.

If the area becomes increasingly painful, red, hot or swollen, or you develop a fever, please contact your referring Breast Consultant or the Imaging department if you cannot reach your consultant.

When should I seek medical advice?

Contact your Breast Consultant, GP or A&E if you experience any of the below:

Bleeding that does not stop with firm pressure
Rapidly increasing swelling of the breast
Increasing redness or warmth around the biopsy site
Increasing or severe pain
Pus or unusual discharge from the wound
Fever or feeling generally unwell
Any other concerns about the biopsy site

If the biopsy site is bleeding, apply firm, continuous pressure with clean gauze or a clean cloth. If the bleeding does not stop, seek medical advice.