Fort Loudoun Breast and General Surgery

Covenant Health System

Breast Center

Fort Loudoun Breast and General Surgery

Hours
  • Breast Center

About Fort Loudoun Breast and General Surgery

Our fellowship trained and board-certified breast surgical oncologist, Dr. Aaron Margulies, specializes in surgery of the breast. Dr. Margulies and his staff believe that education of patients and their families is the first step to recovery and survival when facing breast cancer. He will focus on accurate diagnosis, thorough explanation of all available treatment options, and compassionate surgical care. Our office is conveniently located in Fort Loudoun Medical Center. We’re proud to be a member of Covenant Medical Group, the physician practice group of Covenant Health.

Schedule an Appointment

Our team is ready to provide you with the right care when you need us. We’re accepting new patients. Please note, a referral is required from your doctor.
Aaron Margulies

Meet Dr. Margulies

Dr. Aaron Margulies is a distinguished board-certified general surgeon at Fort Loudoun Breast and General Surgery, renowned for his expertise in treating breast cancer, hernias, and gastrointestinal conditions. He combines precision and compassion in his practice, employing advanced surgical procedures and patient-centered care.

Dr. Margulies attended medical school at the University of Illinois College of Medicine. He completed his residency in general surgery at the University of Tennessee Medical Center in Knoxville, Tennessee, and his fellowship in breast cancer surgery at the University of Arkansas for Medical Sciences Winthrop P. Rockefeller Cancer Institute in Little Rock, Arkansas.


Conditions Treated


Triple Negative (TNBC)

Triple negative breast cancer (TNBC) is an aggressive type of invasive breast cancer where the cancer cells don’t have receptors for estrogen, progesterone, or the HER2 protein. The absence of these receptors makes TNBC more difficult to treat, therefore early detection and surgery are the mainstays of therapy for this type of cancer. Not all triple negative breast cancers are the same, so accurate diagnosis and careful monitoring of the response to treatment are of utmost importance.

Invasive Ductal Carcinoma

Invasive ductal carcinoma (IDC) is a breast cancer that begins in the milk ducts and has spread to other parts of the breast and body. It is the most common type of breast cancer. Surgery (lumpectomy or mastectomy) is often the first line of treatment for IDC. Based on the staging and characteristics of the tumor, radiation, chemotherapy, and hormone therapy may be used in treatment as well.

HER2-Positive Breast Cancer

Approximately 20% of all breast cancers are HER2-postitive, which tend to be more aggressive than HER2-negative breast cancers. If HER2-positive breast cancer is larger than 2cm, patients will need chemotherapy prior to surgery. With the development of new drugs and therapies that specifically target HER2-positive breast cancer, it is now a treatable disease with dramatically improved outcomes.

DCIS

DICS, short for ductal carcinoma in situ, is the earliest stage of breast cancer (stage 0). It is a non-invasive form of cancer limited to the milk ducts of the breast. The recommended treatment is partial mastectomy to remove the cancer followed by radiation, though radiation isn’t required in some cases. Total mastectomy is recommended when DCIS is found in a large portion or multiple portions of the breast. Hormonal therapy is used to prevent other breast cancers from developing in the future.

Inflammatory Breast Cancer (IBC)

Inflammatory breast cancer (IBC) is a rare but aggressive form of breast cancer where cancer cells block lymph vessels in the skin of the breast, resulting in “inflammatory” symptoms such as swelling or redness. An experienced breast surgeon will usually be able to identify inflammatory breast cancer with a physical examination. If the clinical breast exam indicates IBC, a small skin biopsy will be performed to confirm the present of cancer cells. If the diagnosis is IBC, treatment will need to be aggressive since this type of cancer progresses rapidly.

Invasive Lobular

Invasive lobular carcinoma (ILC) is a type of breast cancer that begins in the milk-producing glands of the breast and spreads to other parts of the body. It is the second most common form of breast cancer diagnosed in the US. Depending on the characteristics and stage of the tumor, ILC treatment can involve lumpectomy, mastectomy, radiation and/or chemotherapy, and hormonal therapy.

Procedures and Treatments Provided


Hidden Scar Breast Cancer Surgery

Hidden scar breast cancer surgery is an advanced technique for removing breast cancer during a nipple sparing mastectomy or lumpectomy procedure. With a hidden scar approach, the surgeon will place the incision in a location that is hard to see so that the scar is not visible when the incision heals. As a result, the patient will have little to no visible reminder of the surgery or cancer.

Total Mastectomy with Aesthetic Flat Closure

While a standard total mastectomy can result in a concave appearance, a total mastectomy with aesthetic flat closure is a surgical technique that preserves the natural shape and contour of the chest wall. For women who do not want to undergo complex breast reconstruction procedures, an experienced breast surgeon can perform an aesthetic flat closure that results in minimal scarring and aesthetically pleasing results.

Nipple Sparing Mastectomy with Staged Immediate Breast Reconstruction

A nipple sparing mastectomy with staged immediate breast reconstruction is a surgical procedure that preserves the skin of the breast, including the nipple and areola and is immediately followed by a reconstruction process. The reconstruction starts at the same time as the mastectomy with the first stage typically involving insertion of tissue expanders that allow for future placement of implants.

Partial Mastectomy

A partial mastectomy (also known as a lumpectomy) is a breast-conserving procedure that allows a surgeon to remove the tumor and some surrounding breast tissue without removing the entire breast. This procedure is most often used on small tumors that are detected early. Lymph node removal and treatment will vary depending on the characteristics of the tumor.

Sentinel Lymph Node Biopsy

Sentinel lymph node biopsy is a surgical procedure where the sentinel lymph lode is identified and removed to determine if and how far a cancer has spread. This technique, which is most often performed as an outpatient procedure, uses a smaller incision that shortens recovery times and lowers the risk of side effects like lymphedema.

Patient Information


Patient Forms

Prepare for your visit by filling out these forms ahead of your appointment and bring them with you. This will help us provide you with an efficient visit. Thank you!

Patient Information Form
download
Patient Registration Agreement
download
Authorization to Release Health Information
download
Notice of Privacy Practices
download
Visit Reminders

We ask that you please arrive at least 30 minutes prior to your scheduled appointment. Please bring the following items with you to your visit:

  • Your current health insurance information

  • Your current Photo ID

  • Any medications you are currently taking in their original containers or in a list with dosages and times

Please note: In order to provide efficient care for all of our patients, you may be asked to reschedule your appointment if you do not arrive at least 30 minutes early.

Prescription Refills

It’s very important that you request your prescription refills during normal business hours before 5 p.m. Monday-Friday. Prescriptions will not be refilled on weekends or holidays.

You can request a refill on the MyCovenantHealth Patient Portal or by calling your pharmacy.

Go to MyCovenantHealth
Referrals & Precertification

Referrals

Insurers often require a physician referral prior to your visit to Fort Loudoun Breast and General Surgery. As a courtesy to our patients, we will attempt to contact your primary care physician and request a referral. However, it is your responsibility to confirm that a referral has been obtained before you are seen by our providers.

Precertification

If a test or procedure is ordered by a Fort Loudoun Breast and General Surgery provider, our staff will obtain a necessary precertification on your behalf. Precertification for any tests or procedures ordered by your own primary care physician is the responsibility of your primary care provider’s office.

Patient Survey

Our Patients Are Important

We want to be your first and best choice for healthcare, and we need your feedback.

You will receive a text message or email asking you to complete a confidential and secure survey about your visit. Your feedback will help us continue to deliver excellent care. Thank you!

Had a Great Experience? Leave Us a Google Review!

How to leave a review:

  • Go to Google.com and search for Fort Loudoun Breast and General Surgery
  • When our page listing appears, go to the Review section and click “Write a review”
Leave a Review
quote icon

When you first meet him, he comes across as someone you’ve known before. He’s a calm, compassionate person—it radiates from him. You don’t feel as scared when you sit down and talk to him.

Kathy Brown, Patient

Frequently Asked Questions

What is breast cancer?

The breast is primarily composed of two units: labials that make milk and ducts that carry that milk out. These units are lined by cells which can turn cancerous. When cancerous cells form and stay inside the duct, we commonly refer to it as Ductal Carcinoma In-Situ (DCIS). More often, cancerous cells learn how to escape the duct and invade the breast. This is what we call Invasive Ductal Carcinoma, the most common form of breast cancer. A third form of cancer occurs when the cancer cells form in the labial and then escape the labial. This is called Invasive Lobular Carcinoma.

What are the stages of breast cancer?

Breast cancer has 5 stages as follows:

Stage 0 (DCIS)
Stage I (very early; very treatable)
Stage 2 (still early; may consider more aggressive treatment)
Stage 3 (locally advanced; very aggressive treatment)
Stage 4 (cancer exhibits distant spread; very aggressive treatment)

Regular mammograms and early detection leads to much more effective treatment and better outcomes.

What is the best treatment plan for breast cancer?

Treatment plans will vary by patient but most often consist of the following steps:

1. Presentation of your case before a Breast Tumor Board (a multi-disciplinary team who will come up with the best treatment plan to optimize your outcome)
2. Surgery
3. A return to Breast Tumor Board for finalization of treatment plan
4. Chemotherapy
5. Radiation or reconstruction
6. Anti-estrogen pill

What is invasive breast cancer?

We categorize invasive breast cancer in three ways:

By Type: Invasive Ductal or Invasive Lobular
By Grade: 1, 2, or 3
By Receptors: Estrogen (ER), Progesterone (PR), or HER2; these three receptors are either positive or negative

For example, someone may have Invasive Ductal, Grade 1, ER+/PR+/HR2-

What is the surgical treatment for breast cancer?

There are two ways to treat breast cancer. The first way is to excise the cancer with a rim of healthy tissue around it by performing a lumpectomy. Following this, we add radiation therapy to reduce the risk of a local recurrence. The other option is to remove the whole breast by performing a mastectomy. Many women who choose a mastectomy will elect to have reconstruction. Sentinel lymph node biopsy is the procedure we use to see if and where the cancer has spread to the lymph nodes. This procedure helps determine whether a lumpectomy or a mastectomy is advisable.

What are the qualities to look for in a breast surgeon?

Choosing a breast surgeon you trust is of utmost importance. Some questions to consider when deciding who to entrust with your care include the following:

  1. Does my breast surgeon have advanced training and participate in continuing medical education?
  2. Does my breast surgeon have several years of experience?
  3. How many breast cancer patients does my surgeon treat in a year?
  4. Is my breast cancer surgeon part of a multi-disciplinary breast cancer team?