Scholars@Duke publication: Factors Associated With Procedural Complications in Lactating Patients Undergoing Image-Guided Core-Needle Breast Biopsy.

Factors Associated With Procedural Complications in Lactating Patients Undergoing Image-Guided Core-Needle Breast Biopsy.

Publication , Journal Article

Langman, EL; Kim, C; Yoon, SC

Published in: J Breast Imaging

February 19, 2026

OBJECTIVE: This study investigates patient and procedural factors related to complications in lactating patients undergoing image-guided core-needle breast biopsies. METHODS: This study identified patients who were breastfeeding and underwent biopsies between December 2012 and February 2024. Imaging findings, procedural details, pathology, 30-day complications, and clinical course were reviewed. Factors associated with complications were investigated using Fisher's exact test, logistic regression, and the chi-squared test. RESULTS: A total of 97 biopsies were performed in 88 patients who were lactating (median age 33 years, range 21-47). The median postpartum time at biopsy was 4 months (range 0-5 months). The most common biopsy types included 59/97 (60.8%) 14-gauge US, 19/97 (19.6%) 18-gauge US, and 16/97 (16.5%) 9-gauge vacuum stereotactic. Some 6/97 (6.2%) biopsies yielded malignant diagnoses. The 30-day complication rate was 19/88 (21.6%) patients, with 11/88 (12.5%) developing milk fistula, 10/88 (11.4%) developing infection, and 2/88 (2.3%) requiring surgery or hospitalization. Some 9/11 (81.8%) milk fistulas resolved with continued breastfeeding. Biopsies performed near the obstetric delivery date (P = .03) and biopsy sites closer to the nipple (P = .04) were at increased risk for complication. Patients with milk fistula had significantly elevated infection risk (P = .0003; odds ratio = 16). No statistically significant associations were found between milk fistula formation and biopsy needle gauge or total volume of tissue removed at biopsy. CONCLUSION: A significant portion of patients who are lactating may develop postprocedural complications after core-needle biopsy, but serious complications are infrequent. Biopsy needle gauge is not associated with milk fistula or other complication. Most milk fistulas from core-needle biopsy will resolve without the need to stop breastfeeding.