What is the role of postsurgical breast imaging following excisional breast biopsy?

Updated: Dec 19, 2018
  • Author: Susan Ackerman, MD; Chief Editor: Eugene C Lin, MD  more...
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Answer

Answer

Excisional breast biopsy is usually performed by the surgeon and involves a skin incision and removal of breast tissue. The amount of breast tissue removed and the degree of tissue interruption are variable and are dependent on the surgical technique and subsequent treatment, such as radiation (see the images below). Acute postsurgical changes are most prominent in the immediate postoperative period (as long as 1-2 wk) and are related to hematoma, edema, and tissue disruption. Mammographic images may show an ill-defined mass, area of increased density, skin thickening, and/or distortion.

Craniocaudal mammogram after breast conservation t Craniocaudal mammogram after breast conservation treatment, axillary dissection, and radiation therapy. Note the skin and trabecular thickening (see arrows).
Craniocaudal mammogram demonstrating extensive kel Craniocaudal mammogram demonstrating extensive keloid scarring in the medial aspect of the breast. Note the irregular, macrolobulated, circumscribed densities with wide margins, outlined by a thin surrounding halo of air (see arrows). The keloids are superimposed on the breast tissue on the mammogram and can mimic breast lesions. Careful documentation of skin lesions is important so that dermal lesions are not confused with breast pathology.

Gradually, as healing occurs, the surgical site matures. Fibrosis may occur, leading to scarring. The mammogram may show a spiculated mass, area of architectural distortion, or development of dystrophic calcifications. Some patients may heal with little or no mammographic findings. Seldom, extensive scarring can occur, resulting in keloid formation (see the image below). Careful documentation on the history form and the placement of scar markers can help prevent misinterpretation of these lesions. In general, a baseline postsurgical mammogram is performed 6 months after biopsy. The findings on this mammogram are regarded as the new baseline.

Craniocaudal mammogram demonstrating extensive kel Craniocaudal mammogram demonstrating extensive keloid scarring in the medial aspect of the breast. Note the irregular, macrolobulated, circumscribed densities with wide margins, outlined by a thin surrounding halo of air (see arrows). The keloids are superimposed on the breast tissue on the mammogram and can mimic breast lesions. Careful documentation of skin lesions is important so that dermal lesions are not confused with breast pathology.

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