Stereotactic Breast Biopsy with IV Sedation

What It Is

When an area of concern is seen on a mammogram, a tissue sample will be taken. A stereotactic breast biopsy is a computer-guided procedure that targets a precise location in the breast. The doctor will locate the area and remove the sample using a number of images from a mammogram or ultrasound.

Most stereotactic breast biopsies are done with a local anesthesia or IV sedation.

Stereotactic Breast Biopsy with IV Sedation

If a mammogram shows faint calcifications or a vague mass, the ideal amount of local anesthesia cannot be used, as injecting fluid makes the faint target harder to see. The necessary lower dose of local anesthesia may increase the chance of pain. Additionally, it has been found that women under the age of 30 experienced more pain due to denser breasts.

Intravenous (IV) sedation can make a stereotactic breast biopsy much more comfortable. IV sedation does not put you to sleep but will relax you and make you drowsy.

Even if you do not prefer full sedation, IV sedation can serve as a backup plan should you experience more pain than anticipated.

Through the Saul and Joyce Brandman Breast Center – A Project of Women's Guild, hundreds of patients have undergone stereotactic biopsy with IV sedation with no airway or safety issues. To qualify for this method:

  • You must be in reasonably good health
  • If you have high blood pressure or diabetes, it must be well-controlled

IV sedation usually won't be available if you have had:

  • A recent heart attack
  • A recent hospital admission for congestive heart failure
  • Sleep apnea requiring bilevel positive airway pressure (BiPAP) at night
  • If you're over age 45, you'll need to have had an electrocardiogram and a complete blood count exam in the past two months.

Before the Exam

  • You must not eat or drink anything for eight hours before the procedure. Medication can be taken with a small sip of water.
  • Take all your usual medication as prescribed by your physician except for aspirin, Advil, ibuprofen and blood-thinning medications.
  • Talk to your doctor if you're on Coumadin or another blood thinner before scheduling your appointment.
  • You may take pain medication, such as Tylenol.
  • Don't take vitamin E for five days before your procedure.
  • Please leave your jewelry and valuables at home.

At the Hospital

  • You will change into a patient gown. You will need to remove your clothes from the waist up.
  • Before the exam, please talk to your doctor or nurse about any allergies you may have.
  • The doctor will explain your procedure and answer any questions you may have. The doctor also will explain the risks and benefits of the procedure before you sign a consent form.

During The Exam

Breast biopsies are performed two ways:

1. You may be asked to lie face down on a special table with your breast positioned through a round opening in the table. The table will be elevated so the imaging physician and the technologist can work from below.
2. Or the procedure may be performed with you in a seated position.

A stereotactic breast biopsy generally takes between 60 and 90 minutes.

1. You will lie face down on a special table. Your breast will be positioned through a round opening in the table. The table will be elevated so the medical team can work from below.
2. The first part of the procedure will seem much like your mammogram. An X-ray will be taken to ensure that the area of the breast with the area of concern is correctly centered in the window.
3. If you have chosen IV sedation, a nurse will begin the procedure by inserting an intravenous line. This won't put you to sleep but will relax you and make you drowsy.
4. When the position is confirmed, two stereo X-rays will be taken. These are called stereo because the images are of the same area but taken from different angles. From these images, the computer helps determine the exact location for the biopsy.
5. The doctor will use a very small needle to numb the biopsy area with a long-acting local anesthetic. You may feel a slight sting in your breast where this is applied.
6. After the area is numb, the doctor will insert the biopsy needle into your breast. Another set of stereo X-rays will be taken to confirm correct needle placement. Once placement is confirmed, you will need to hold very still while the tissue sample is taken.
7. The needle with the sample is removed. Several more samples of the area will be quickly taken.
8. When the doctor has taken all the samples, a titanium clip will be placed within the biopsy site. This will mark the site for future reference. A set of stereo X-rays will be taken to make sure the clip is in the correct place.
9. A mammogram will be taken after the biopsy to ensure the proper placement of the clip.
10. After all the samples are taken, the nurse or technologist will apply pressure to the biopsy site for five to 10 minutes to prevent bleeding. A dressing will then be applied.

After The Exam

A mammogram will be taken after the biopsy to document the placement of the clip and removal of tissue samples. A bandage will be applied to the site and you will be sent home.

You will be given home care instructions prior to being sent home.

General Information

Some patients report no pain during the biopsy, while others report mild to severe discomfort with local anesthesia. Some patients take an oral anti-anxiety medication to calm them prior to the procedure.