Vacuum-Assisted Excision (VAE): A Minimally Invasive Option for Breast Lesion Removal

Vacuum-Assisted Excision (VAE) is becoming an increasingly popular option for removing small breast lesions without the need for traditional surgery. It offers a safe, accurate, and minimally invasive way to diagnose or remove certain abnormalities — often with a faster recovery and little to no scarring.

I offer VAE for suitable patients at our Chadstone rooms as part of my commitment to modern, patient-centred breast care.

What Is VAE?

VAE is a procedure that uses a specialised needle device to remove breast tissue through a tiny skin incision (usually 3–5 mm). It is performed under local anaesthetic, meaning the area is completely numbed but you remain awake.

Using ultrasound guidance, the surgeon positions the device precisely at the lesion and removes the tissue using a gentle vacuum suction mechanism. In many cases, this avoids the need for a traditional day-surgery operation under general anaesthetic.

Who Is VAE Suitable For?

VAE is an excellent choice for patients with B3 lesions — also known as lesions of uncertain malignant potential — diagnosed on a core needle biopsy. These are a group of breast abnormalities where the initial biopsy shows changes that are not clearly benign but not definitively cancerous either. Because there is a small chance that an underlying cancer may be present, further tissue sampling or excision is recommended.

The most common B3 lesions include:

• Intraductal papilloma and papillary lesions

• Radial scar / Complex sclerosing lesion

• Atypical ductal hyperplasia (ADH), Atypical lobular hyperplasia (ALH) & Lobular carcinoma in-situ (LCIS)

Until recently, open surgical excision was the standard recommendation after a core biopsy showed a B3 lesion. However, Vacuum-Assisted Excision — when performed by experienced specialists — is now widely recognised as an excellent, minimally invasive alternative for many B3 lesions.

How Is the Procedure Performed?

Here is a step-by-step look at what actually happens:

1. Preparation

You will lie comfortably on the ultrasound table. The skin is cleaned, and a local anaesthetic is injected to numb the area — most people describe only brief stinging.

2. Small Skin Incision

A tiny cut (3–5 mm) is made. This is usually so small that no stitches are required afterward.

Vacuum-assisted biopsy/excision device

3. Device Placement

Using real-time imaging, the VAE device (a hollow needle with a rotating cutter inside) is positioned directly at the lesion.

4. Vacuum-Assisted Removal

Once in position:

• A gentle vacuum draws tissue into the device

• The rotating cutter removes the targeted area

• The tissue is suctioned through the needle into a collection chamber for pathology

5. Compression & Dressing

The incision is closed with a steri-strip or small dressing. A compression bandage may be applied to reduce bruising.

The entire procedure typically takes 20–40 minutes depending on the lesion size.

Post-Procedure Recovery

One of the advantages of VAE is the quick and straightforward recovery.

You can expect:

• Mild bruising or swelling for a few days

• Some tenderness in the area

• Minimal scarring or no visible scar at all

Most patients return to normal daily activities within 24 hours, avoiding heavy exercise for a few days. You will be asked to apply ice to the site and wear a firm sports bra for the first 1–2 days to reduce bruising.

Benefits of VAE Compared With Open Surgery

Many women prefer VAE because it offers:

✔ Minimal scarring: The incision is only a few millimetres.

✔ No general anaesthetic: You stay awake and comfortable throughout.

✔ Faster recovery: Most women feel back to normal quickly.

✔ Excellent cosmetic results: No stitches and less tissue disruption.

✔ High diagnostic accuracy: Large tissue samples allow for thorough pathology assessment.

✔ Can completely remove many benign lesions: In many cases, open surgery becomes unnecessary.

Risks and Limitations

VAE is very safe, but as with any procedure, risks include:

• Bruising or haematoma (blood collection)

• Discomfort for a few days

• Rare infection

• Rare incomplete removal (occasionally needing further surgery)

Your surgeon will discuss whether your lesion is suitable for complete removal via VAE.