Vacuum Assisted Breast Biopsy
VACCUM ASSISTED BREAST BIOPSY(VABB)
Vaccum assisted breast biopsy (VABB) is a minimally invasive procedure used to remove suspicious area in the breast.It is typically performed when a lump or abnormality is detected on a Mammogram , Ultrasound or MRI.
KEY FEATURES OF VABB:
1)Vaccum Technology:
A vaccum powered instrument helps to collect multiple tissue samples through a single small incision.
2)Image Guidance:
This procedure is done with the help of imaging to precisely locate the abnormal area, like..
a)Mammography guidance- Called as Stereotactic VABB
b)Ultrasound guided VABB
c)MRI guided VABB
3)Minimally Invasive:
Unlike surgical biopsy/ excision biopsy ,VABB does not require stitches and usually leaves minimal or No scar within breast skin.
4) Local Anesthesia:
The area is numbed locally , so patient remains awake but can not feel any pain. No general Anesthesia is needed.
5)Outpatient procedure:
It typically takes about 30-60 minutes and sometimes hardly less than 10 minutes and does not require overnight hospital stay. Patients are normally discharged one hour after the procedure.
6) Recovery:
Has a fast recover time. Patients returns to normal activities in about 24 hrs.
Why VABB is done?
Diagnostic indication:
- Stereotactic VABB: to determine whether an abnormal area on mammogram is benign or malignant e.g.
- Tiny clusters of microcalcifications
- A small area of architectural distortion
- Asymmetric density on mammogram.
- A new small mass or nodule or a newer area of microcalcifications in a previous surgery site
ULTRASOUND guided VABB:
Very small lesions difficult to target with Core needle biopsy
- Discordant pathological – radiological findings.
- Non mass like lesions / ductal lesions like suspected ductal carcinoma in situ or suspected lobular carcinoma
- Papillary lesions.
MRI Guided VABB diagnostic indications:
- Indicated only in MRI visible lesions.
- Non mass enhancement visible only on MRI
Therapeutic Indication of VABB:
Refers to situations where it is used not just for diagnosis , but also for treatment, typically for removing benign lumps/ lesions –like fibroadenoma , Benign phyllodes , Small Papilloma, Complex cyst ,Focal fibrosis ,PASH- Pseudoangiomatous stromal hyperplasia ,Sclerosing adenosis ,Complex sclerosing lesion / Radial scar.
How is the VABB Procedure done?
1. Positioning
Depending on the imaging guidance used, you will be placed:
- Ultrasound-guided: lying on your back or side.
- Stereotactic (mammogram-guided): lying face-down on a special table or sitting upright.
- MRI-guided: lying face-down in an MRI machine.
2. Skin cleaning and numbing
- The skin is cleaned with antiseptic.
- The Breast radiologist injects local anesthesia (like lidocaine). Within a few minutes, the area becomes numb—patients usually only feel pressure, not pain.
3. Small skin incision
A tiny cut (about 2–6 mm) is made so the probe can enter. No stitches are usually needed.
4. Inserting the VABB probe
A hollow probe (slightly larger than a core needle) is inserted through the incision and positioned exactly at the lesion using imaging. You will feel pressure but not sharp pain.
5. Tissue sampling with vacuum suction
This is the main step:
- The vacuum sucks tissue into the probe’s opening.
- A rotating cutter inside the probe removes the tissue sample.
- Tissue is collected in a chamber—multiple samples with only one insertion.
- The doctor may take 8–24 samples, depending on the lesion size and type.
You may hear clicking or suction sounds — this is normal.
6. Clip (marker) placement
A tiny metal clip (usually titanium) is placed at the biopsy site.
- It stays in the breast permanently.
- It does not set off metal detectors.
- It helps locate the area on future scans or surgery if needed.
7. Removing the probe and closing the incision
- The probe is removed.
- Pressure is applied for several minutes to stop bleeding.
- Steri-strips or a small bandage are applied.
No stitches are usually required.
8. Post-procedure care
- Ice pack for swelling
- Wear a snug, supportive bra
- Avoid heavy lifting for 24–48 hours
- Bruising and soreness are normal for 1–2 weeks
How painful is the VABB procedure?
Vaccum assisted breast biopsy technique is painless as it is done in local anesthesia.Most of the patients feel only pressure , tugging or vibration.
How long does the VABB procedure takes?
Usually the VABB procedure takes 10 to 40 minutes , depending on the lesion and guidance method.
How large is the incision given in skin? Stitches are rquired?
Typically 2-4 , just a tiny skin nick is done. No stitches are usually needed , hence it is scarless procedure.
Why a marker clip is placed after the procedure?
A small titanium clip/ breast tissue marker clip is placed , so that the site where the biopsy has been taken or site where the VABB excision has been done can be found later on in Imaging.
How long does it take to recover from a vacuum assisted biopsy?
First 24 hours
- Mild pain, bruising, or swelling
- Keep bandage dry
- Avoid heavy lifting, exercise or swimming
- Use ice packs as needed
1–3 days
- Most soreness improves significantly
- Bruising may still be present
- Many people feel comfortable returning to normal activities (except heavy workouts)
1 week
- Bruising fades
- Tenderness mostly gone
- You can fully resume normal activities, including exercise, unless your doctor advised otherwise
2 weeks
- Most people feel completely back to normal
- Bruising should be nearly resolved
*Overall:
Most people recover in 2–7 days, with full comfort usually within 1–2
weeks.
Tips for a smoother recovery
- Wear a supportive bra for 24–48 hours
- Ice the area for the first day
- Avoid aspirin/ibuprofen if your doctor advised it (can increase bruising)
- Avoid swimming or soaking until the incision heals (usually 48 hours)
- Watch for signs of infection: increased redness, warmth, fever, or drainage
What are the common complication of Vaccum Assisted Breast Biopsy?
- Bruising / hematoma
- Infection
- Prolonged tenderness
- Rarely bleeding
What is the difference between a core biopsy and a vacuum assisted biopsy?
- Core Needle Biopsy:
Uses a spring-loaded hollow needle. Each sample is taken one at a time.
- Vacuum-Assisted Biopsy:
Uses a larger probe connected to a vacuum suction system. Multiple samples are collected in one insertion
2. Sample Size & Number
- CNB:
Small core samples (usually 3–6 pieces).Sample size limited.
- VABB:
Larger, more continuous tissue samples collected.
Often yields more tissue and better for small lesions, calcifications, or areas requiring precise sampling.
3. Accuracy
- CNB:
Very accurate, but limited sampling may miss very small lesions.
- VABB:
Higher diagnostic accuracy for:
- Microcalcifications
- Architectural distortions
- Very small lesions
- Lesions difficult to target
Because more tissue is removed, the chance of sampling error is lower.
4. Guidance Method
Both can be done with:
- Ultrasound
- Stereotactic (mammogram-guided)
- MRI guidance
But VABB is especially preferred for stereotactic biopsies (e.g., calcifications).
5. Healing & Comfort
- CNB:
Smaller needle → slightly less bruising.
- VABB:
Larger probe → may cause more bruising or hematoma, but still minimally invasive.
6. Lesion Removal
- CNB:
Only small tissue samples; cannot remove whole lesions.
- VABB:
Can sometimes remove entire small benign lumps (like small fibroadenomas), avoiding surgery.
7. Time & Cost
- CNB:
Faster and cheaper.
- VABB:
Longer procedure and more expensive due to the device and vacuum system.
