The Department of Surgical Oncology at City of Hope Atlanta, provides a variety of surgical procedures to treat cancer and cancer-related symptoms.
Because many of our patients come to us with complex and advanced-stage cancers, the surgical oncology team is experienced in providing a wide variety of surgical procedures for all types and stages of disease.
Your surgical oncology team includes surgical oncologists and surgeons with advanced training in various surgical techniques, as well as nurses, surgical technicians, anesthesiologists and other cancer professionals with diverse expertise in treating all types and stages of cancer. We work closely with you to find surgical options tailored to your individual needs and preferences, to help you feel confident in and comfortable with your treatment decisions. What to expect:
Before surgery, we will explain what you can expect, answer your questions and help you feel comfortable with the upcoming procedure.
During surgery, our pathologists can evaluate tissue samples as they are removed and provide pathology results immediately. This helps your surgical oncology team remove as much cancerous tissue as possible during surgery, reducing the likelihood that you will have to undergo multiple surgeries.
After surgery, your care team will work with you to help prevent and manage side effects. You may also have reconstructive surgery to restore appearance or function.
Our experienced surgeons have performed thousands of procedures and will discuss the surgical options designed to fit your individual needs. We also provide minimally invasive surgical procedures, which may help reduce side effects and recovery time.
Whether a patient is a candidate for surgery depends on factors such as the location, size, type, grade and stage of the tumor, as well as the patient’s age, general health and other factors. The goal of surgery may be to remove the tumor (e.g., excisions, resections, debulking surgery), reconstruct a part of the body (e.g., restorative surgery).
For some patients, surgery may be combined with other cancer treatments, such as chemotherapy, radiation therapy or hormone therapy, administered before or after surgery to stop cancer growth, spread or recurrence.
Early in the treatment planning process, we plan for and proactively manage side effects from surgery. Our nutritionists, rehabilitation therapists and naturopathic clinicians work together with your surgical oncologist to support your healing and quality of life. Our reconstructive surgeons perform procedures to restore the body's appearance and function, often at the time of surgery or following surgery.
The Department of Surgical Oncology at City of Hope Atlanta is staffed by surgical oncologists, as well as anesthesiologists, surgical technicians, physician’s assistants and wound care certified registered nurses. Our team makes sure that our patients have a full understanding of their cancer treatment options and give them a full understanding of what to expect.
For our surgeons, formulating an individualized treatment plan begins with a thorough review of your medical records prior to your visit to City of Hope, coupled with the findings of our intake clinicians. Your surgical oncologist will also examine lab findings and imaging studies, and meet with other members of your care team.
While removing malignant tumors is the primary objective, the surgical oncology team at City of Hope Atlanta also understands the importance of quality of life
Throughout your treatment, you will also receive supportive care services to help reduce cancer-related fatigue, functional impairments and other side effects to help you maintain your quality of life during treatment.
Breast Surgical Oncologist Anita Johnson, MD, FACS, works collaboratively with our plastic and reconstructive surgeons and the rest of the multidisciplinary oncology team to develop each patient’s surgical care plan. Plastic & Reconstructive Surgeon Fred Durden, MD, leads the breast reconstruction program at City of Hope Atlanta. Dr. Durden is double board-certified by the American Board of Plastic Surgery and the American Board of Otolaryngology-Head and Neck Surgery, and completed a fellowship in microsurgical reconstruction. Dr. Johnson, Director of Breast Surgical Oncology, is fellowship-trained Breast Surgical Oncologists providing advanced surgical techniques, such as oncoplastic surgery, which combines principles of plastic surgery with cancer surgery, such as nipple-areola-sparing, areolar-sparing and skin-sparing mastectomies for cancer patients, as well as those determined to be at high-risk for the disease
Nipple-areola sparing mastectomy: This procedure keeps intact the nipple and areola, and preserves the breast skin, but removes the breast tissue. Unlike a traditional mastectomy, it preserves a thin layer of fat and blood vessels needed to maintain adequate blood flow and protect the skin’s viability. Because most of the nerves are removed during the mastectomy, the preserved skin and nipple often become permanently numb. A nipple-sparing mastectomy, combined with immediate breast reconstruction, may produce a reconstructed breast that looks similar to the original breast, with the skin and nipple intact.
Skin-sparing mastectomy: This technique involves removing breast tissue while preserving the outer skin. This less-invasive approach to a mastectomy helps preserve the breast’s natural contour and shape while reducing the risk of scarring. Reconstruction options following a skin-sparing mastectomy include silicon or saline breast implants and autologous fat grafting or tissue transfer. While both procedures use the body’s own cells to reform the breast, fat-grafting techniques transfer fat cells from other areas of the body, while tissue transfers transplant tissue from the abdomen, back, buttocks and other regions.
Our breast center team offers a variety of techniques to help restore the appearance of the breast and nipple area. The team has expertise in the wide array of breast reconstruction techniques, including options for patients with weight concerns due to very low or very high body mass index.
Changes to your body may raise concerns about sexuality and femininity. Our goal is to provide you with an interdisciplinary team that can address non-surgical needs, as well. Our breast surgical team works closely with clinicians who offer evidence-informed therapies, including mind-body therapists, oncology rehabilitation providers, licensed dietitians, counselors, lymphedema-certified therapists and other clinicians, to offer advice, resources and therapies to support your overall well-being.
At City of Hope Atlanta, we recognize that treating breast cancer patients involves more than removing the tumor. Our plastic and reconstructive surgeons work closely with our breast surgical oncologists to provide quality surgical care for our patients. Breast cancer treatments can change how patients look, feel and function. The decision to have breast reconstruction surgery is personal and involves a thorough discussion with a plastic surgeon who partners with you to achieve your goals. For many women, restoring the appearance of one or both breasts may benefit their physical and emotional recovery.You may consider breast reconstruction:
Candidates for breast reconstruction have been:
At City of Hope, our plastic and reconstructive surgeons will discuss your breast reconstruction options before or after a lumpectomy or mastectomy is performed, when appropriate. This conversation is designed to help you make more informed decisions about your care. Our surgeons are trained to revise misshapen breasts and/or improve breast symmetry that may result after a cancer treatment. They also treat cancer patients who have decided to postpone reconstruction after radiation therapy. Women who seek breast reconstruction typically want a natural-looking breast that is symmetrical with the unaffected breast, and reconstruction can occur immediately at the time of the cancer operation or after chemotherapy and/or radiation are complete.
Breast reconstruction options may include reshaping techniques to reduce defects or improve symmetry; implants-based reconstruction; or microsurgical procedures using the patient’s own skin and tissue (autologous techniques). Recommendations may vary based on many factors, including the location and size of tumors, body mass index, smoking status and chronic diseases such as diabetes. A consultation with a plastic and reconstructive surgeon may provide valuable insight into questions like whether you are a good candidate for the surgery, as well as details about your options and what timing is appropriate for your needs.
Types of reconstructive surgery include:
Immediate breast reconstruction: When appropriate, some women may choose immediate reconstruction of their breast(s) at the same time as their mastectomy
Staged breast reconstruction: This option rebuilds the breast in several stages to reduce the risk of complications. Many women who require radiation therapy may be advised to have staged breast reconstruction, such as an immediate tissue expander instead of immediate direct implant reconstruction. Once radiation therapy is complete and the tissue has recovered, the expander used to maintain the shape of the breast is removed and replaced during final reconstruction, either with the patient’s own tissue, transplanted from a donor site or a silicone or saline implant.
Advantages |
Disadvantages |
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Allows any needed treatment, such as radiation, to begin after mastectomy. |
Waiting for reconstruction requires patients to live for a time without breasts, which may lead to self-image challenges. |
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Staging the surgery allows radiated tissue to heal. |
Multiple procedures raise the risk of infection. |
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Using an expander, the surgeon is able to create a pocket to provide support for an implant. |
Performing the surgeries in stages extends the total time needed for total reconstruction. |
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It is better to have expanders exposed to bacteria that may potentially form after a mastectomy than implants, as the expanders will be permanently removed. |
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During the breast cancer treatment planning process, a plastic and reconstructive surgeon will discuss your medical needs and goals. If you received chemotherapy prior to surgical planning, you may be at risk for side effects such as lymphedema, hair loss, nausea and pain. Our goal is to provide you with a comprehensive care plan to help support your needs at multiple levels.
A common breast reconstruction procedure involves the use of saline or silicone implants. This option often occurs in two stages. The first includes inserting a tissue expander. The second stage involves removing the tissue expanders and inserting a permanent implant.
As part of a lumpectomy or partial mastectomy procedure, various plastic surgery techniques may be used to reshape the breast and create symmetry after the cancer is removed. Oncoplastic surgery combines the principles of plastic surgery with breast surgical oncology to achieve an aesthetic result. Oncoplastic reconstruction may be recommended for patients who have sufficient breast tissue after cancer removal surgery without the use of implants or tissue transfers.
Oncoplastic reconstruction techniques include:
Corrective surgery repairs: Patients who experienced an unsatisfactory breast reconstruction that resulted in an abnormal breast appearance following a mastectomy may choose corrective surgery to restore the breast to a more natural look.
3-D nipple tattoo: Instead of using tissue to rebuild a nipple, some women choose to have a nipple tattooed on the reconstructed breast. Many 3-D nipple tattoos provide realistic results by darkening, contouring and shading the nipple area to match the opposite breast.
Compared to implant-based reconstruction, autologous procedures typically require more time and a longer recovery period. Because they use the patient’s own tissue, these techniques may yield more natural results. The tissue and skin may be transplanted from various areas of the patient’s body, and the area and method chosen will depend on the amount and quality of tissue available.
The tissue (called a "flap") usually comes from the belly, the back, buttocks or inner thighs to create the reconstructed breast. Autologous breast reconstruction techniques are classified based on the composition of the flaps and the source of the tissue. City of Hope offers a wide array of tissue transfer procedures, including:
Deep inferior epigastric artery perforator (DIEP flap surgery) This microsurgical procedure moves fat, skin and the blood supply from the lower belly to the breast.
Stacked DIEP flap reconstruction: A newer approach to DIEP, this procedure is used to reconstruct one breast in women who don’t have adequate extra belly tissue and are therefore ineligible for standard DIEP surgery.
Transverse rectus abdominis myocutaneous (TRAM) flap surgery: This operation also uses abdominal tissue and is typically shorter in duration than the DIEP flap surgery. It is performed less often because it affects the core abdominal muscles.
Latissimus dorsi flap: This procedure uses muscle, skin and fat from the back. Similar to implant reconstruction, it is performed in two stages.Autologous fat grafting: This technique uses liposuction to remove fat from one area of the body, such as the belly, and transfers it to the breast, allowing surgeons to fine-tune the breast’s shape. Fat is a rich source of stem cells, which are critical to healing. Transferring fat may help nurture the formation of new blood vessels, improve skin texture and, in some cases, restore some lost sensation.
