Is surgery really necessary?

I understand why your doctor is recommending that the lump be entirely removed, and personally I agree with that approach. 

First, it's not unusual that your doctor can't identify whether your lump is cancerous or not from the way it looks on the ultrasound.  It is not possible for any doctor or radiologist to identify a cancerous mass just from a film, whether it's an ultrasound, a mammogram or an MRI.  Sometimes a doctor may have a pretty good idea that a mass appears cancerous, but the only way to know for sure is through a biopsy. 

There are two categories of biopsies - needle biopsies and surgical biopsies.  More often, a needle biopsy is done first, because it's non-invasive.  In this case, if the mass is benign and the mass can be left in the breast, then no further action is required.   Sometimes, though, a doctor will recommend that the mass be fully removed via a surgical biopsy  - what's called an excisional biopsy - as the first step.  This is what your doctor is doing.  This is done is cases where the doctor feels strongly that regardless of the result, the mass should be removed from the breast.  This is often because of a concern that if a mass is relatively large (as yours is), it can block the view of the breast tissue when you have future tests.  So even if the mass is benign, in the future if you had problems, they might be hidden on a mammogram or ultrasound by this mass. 

If you are uncomfortable with the doctor's suggestion to have the excisional biopsy, then ask to have a needle biopsy first.   Then you will know what you are dealing with.  But at your age, I completely understand why the doctor would want to remove the entire mass so that you have clear breast tissue for any future testing.

You should get the lump out, the sooner the better, because you don't know what it is and you won't know until it's out.

I had a lumpectomy as an outpatient with tranquilizer and it went very nicely. Very little pain and it healed very quickly.  In fact, I can't even see the scar any more (this was a year ago).

Keep in mind that once any cancer cells has leaked beyond the breast there is little that anyone can do to keep it from spreading.  The best cure for BC is early detection and surgery.

Good luck! 

If the lump is in a place where needle biopsy is not a reasonable option, then you have to have an excisional biopsy.  It sounds like his approach is reasonable. You are going to have to get this thing looked at one way or another.  You might want to pursue a second opinion to make sure that a surgeon cannot do an ultrasound-guided needle biopsy. If it came back malignant, then you could hit it with neoadjuvent chemotherapy.There is a 30% chance that you might not need surgery at all after that.