Breast Clinic in Minnesota

Breast Surgery

Physicians in the Breast Diagnostic Clinic and Breast Cancer Clinic will coordinate surgical care for patients who choose this treatment option. Breast surgeons and plastic surgeons form the core of the patient's surgical team and work together to provide the most appropriate care for the patient.

At Mayo Clinic, patients diagnosed with breast cancer often can be scheduled for surgery the next day, if desired. After the cancer has been removed, Mayo Clinic pathologists and/or radiologists immediately evaluate the tissue and report results directly to the surgeon while the operation is still under way. Direct, face-to-face contact with the pathologist allows the surgeon to verify the tumor's margin (edges) and make a more informed diagnosis.

During surgery, the surgeon removes the cancer along with a rim of normal tissue and sends it to the pathologist. The pathologist rapidly freezes the edges of the tissue using a machine that maintains a constant temperature, which allows the tissue to be cut into very thin sections (5-15 microns) using a microtome. These thin frozen sections are stained with specialized solutions and placed on a glass slide, which the pathologist then reviews under the microscope. The entire process takes 15 to 20 minutes, and allows immediate diagnostic feedback that may change the course of surgery.

This frozen section procedure helps the surgeon assess breast margins following a lumpectomy or mastectomy to ensure that all of the cancer is removed. If the frozen section analysis reveals that the tissue sample contains cancer cells, the surgeon can proceed to take additional tissue from the area while the patient is still in the operating room. The ability to determine whether additional tissue should be removed reduces the need for additional surgery. The frozen section laboratory is located adjacent to the operating rooms to quickly provide surgeons with accurate information.

Breast Cancer Surgery

Several surgical options are available at Mayo Clinic including lumpectomy, simple or total mastectomy, modified radical mastectomy, and sentinel lymph node biopsy.

Lumpectomy. This operation saves as much of the breast as possible by removing only the lump plus a surrounding area of normal tissue. The surgeon will likely also remove some lymph nodes to check for possible spread of cancer. In most cases, the operation will be followed by radiation therapy to kill any remaining cancer cells.

Simple or total mastectomy. During a simple mastectomy, the surgeon removes all the breast tissue — the lobules, ducts, fatty tissue, and a strip of skin with the nipple. Depending on the results of the operation and follow-up tests, patients may also need further treatment with radiation, chemotherapy, or hormone therapy. Most often these patients will also need a sentinel lymph node procedure.

Modified radical mastectomy. In this procedure, a surgeon removes the entire breast and most of the underarm lymph nodes, but leaves the chest muscles intact.

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Sentinel lymph node biopsy. One of the first places breast cancer spreads is to the lymph nodes under the arm. That is why nearly all women with invasive cancer need to have these nodes examined. If the sentinel nodes — the first nodes to receive the drainage from breast tumors and therefore the first to develop cancer — are removed, examined and found to be healthy, the chance of finding cancer in any of the remaining nodes is very small, and no other nodes need to be removed. This spares many women the need for a more extensive operation and greatly decreases the risk of complications such as arm lymphedema. However, if any of the sentinel nodes contain disease, an axillary lymph node dissection is recommended and performed during the same surgery.

Breast Reconstruction after Cancer Surgery

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If reconstruction is an option, a Mayo Clinic plastic surgeon specializing in breast reconstruction can perform the surgery. Mayo Clinic offers reconstruction either with implants or with the patient's tissue followed by nipple and areolar reconstruction.

Reconstruction with implants. Following a mastectomy, the plastic surgeon begins the reconstruction process by placing a tissue expander beneath the muscles of the chest wall. The patient then receives a series of injections of saline into the expander as an outpatient until the desired breast size is achieved. The expander is then removed and a permanent implant, either silicone or saline, is placed. This procedure can take up 1 year to complete.

Reconstruction with the patient's tissue. Breasts can also be reconstructed using a patient's tissue. Usually the transverse rectus abdominis myocutaneous (TRAM) muscle is used with the overlying abdominal tissue. The TRAM is rotated into position or may require a free flap (a microvascular connection of the vessels) for positioning. Other tissue that can also be used include the latissimus dorsi from the back or the gluteal muscles from the buttocks.

TRAM procedure

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The deep inferior epigastric perforator (DIEP) flap procedure is another option for women who would like a breast mound present immediately after reconstructive surgery. This procedure has several benefits — a faster recovery period than traditional TRAM flap surgery, no loss of abdominal muscle tone and the "effect" of a tummy tuck because excess tissue is removed from the abdomen to reconstruct the breast.

Reconstruction of the nipple and areola. After initial surgery with either an implant or the patient's tissue, the nipple and areola can be reconstructed. A mound of tissue is made from nearby skin to create a nipple, which is then surrounded by tattooed coloration.