Patient-perceived cosmesis and satisfaction after breast biopsy: comparison of stereotactic incisional,excisional, and wire-localized biopsy techniques

BACKGROUND: Several options exist for obtaining tissue for pathologic diagnosis of nonpalpable breast lesions. They are generally divided into traditional, open wire-localized biopsy through a 3- to 5-cm incision, stereotactic-guided excisional biopsy through a 1- to 2.5-cm incision, and stereotactic-guided incisional biopsy through a puncture wound a few millimeters long. Because all 3 techniques are reliable, cosmesis has been suggested to be a critical issue driving procedure choice. However, no study has surveyed breast biopsy patients themselves as to the importance of this issue. METHODS: We conducted telephone interviews with 59 women who underwent wire-localized biopsy (WL), stereotactic incisional biopsy with the Mammotome device (Mammo), or stereotactic excisional biopsy with the ABBI device (ABBI). All patients had benign diagnoses, were at least 2 years after procedure, and were matched to age and race. The questions were (1) How would you rate your scar? (2) Were you satisfied or dissatisfied with your biopsy experience? (3) Which is more important to you-complete removal of the abnormality or scar appearance? (4) Do you have any additional comments? RESULTS: Eighty percent of patients ranked complete removal of the abnormality more important than cosmesis. Ninety-five percent of the ABBI and Mammo patients rated their scar as excellent, whereas only 25% of WL did (P =.02). Ninety percent of WL patients, 80% of Mammo patients, and 75% of ABBI patients were satisfied with their experience (P = not significant). Many of the reasons for dissatisfaction were related to service quality rather than medical quality. CONCLUSIONS: Complete removal of the mammographic abnormality may be the priority for patients undergoing breast biopsy. There did not seem to be patient-perceived difference in cosmetic result between the Mammo and ABBI patients. Patient satisfaction is multifactorial, and attention must be paid to these issues generally ignored by physicians.