The blog of Dr. Anne Peled, board-certified plastic surgeon. Dr. Peled discusses breast reconstruction and breast cancer surgery topics and operates in the San Francisco area.

BREAST RECONSTRUCTION AWARENESS DAY 2017: KNOW YOUR OPTIONS

Fortunately for women undergoing breast cancer or breast cancer prevention surgery, the choices available for reconstruction just keep getting better and better.   New technologies and techniques help women get back to looking and feeling like themselves faster and better than ever.   These new approaches allow women to move past their cancer treatment to return to their lives without constant reminders of their diagnoses and the stress of treatment.  Here are a few of the most exciting new trends and technologies that truly improve breast reconstruction outcomes:

Lumpectomy reconstruction (“Oncoplastic” surgery)

While lumpectomy is a very effective cancer surgery, the appearance of the breast can become deformed after lumpectomy, which can worsen with radiation therapy.   Given how many women have lumpectomies every year, coming up with ways to improve the look of the breast after surgery is incredibly important, which is why “oncoplastic” surgery was developed.  Oncoplastic surgery involves:

Placing lumpectomy scars more cosmetically

Filling the defect left after removing the cancer

In some cases, reshaping the breast with a breast lift or breast reduction at the time of lumpectomy, which can make the breasts look even better than they did before cancer surgery

Certain newer technologies, such as better lighting of the lumpectomy area during surgery or devices to help fill lumpectomy cavities, can help surgeons offer even better oncoplastic surgery to women.

One-stage implant reconstruction

Reconstruction with implants has often been thought of as being done in two stages, with a temporary implant (tissue expander) placed at the time of mastectomy and then switched at a later surgery for a permanent implant.   However, most women can safely have their permanent implants placed at the time of their mastectomy, which has many benefits:

Avoiding the need for a second surgery and the associated recovery and costs

Avoiding the potential discomfort of tissue expanders, which are more rigid than permanent implants

Decreasing the chance of potential healing complications from implant exchange surgery

Above-the-muscle breast reconstruction (“Pre-pectoral” reconstruction)

With the development of tissue scaffolds for breast reconstruction, implant breast reconstruction can now be safely performed with implants placed over the muscle. Some of the advantages of placing implants over the muscle during breast reconstruction include:

Faster recovery after surgery

Less pain after surgery, both short- and long-term

More natural shape to the reconstructed breast

 

Improvements in types and shapes of breast implants have made breast reconstructions look and feel more natural and given women more choices to find the look that’s right for them.

Fat grafting

For both mastectomy and lumpectomy reconstruction, fat from another part of the body can be used to help improve the appearance of the breast.  Fat transfer can help make the breast look more natural, particularly in women having implant reconstruction.  The newest advances in fat grafting systems help ensure the best and safest outcomes for women.

To learn more about these breast reconstruction techniques, contact Dr. Anne Peled at 415-923-3011, contact This email address is being protected from spambots. You need JavaScript enabled to view it. or visit annepeledmd.com.

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What’s your Dream Shape? Moving beyond the “Mommy Makeover”

I was recently at a meeting with a talk about “Mommy Makeovers”, a term popularized in social media for women looking to improve their appearance following pregnancy and having children.  As a plastic surgeon and a mother, I’ve never liked the term, thinking it takes the focus off of women wanting to look and feel their best for any number of reasons, where body changes following pregnancy may or may not play a big role. And even if body changes after having children is the major reason a woman is seeking to improve her appearance, she is often not wanting to make over her image as a “Mommy”, but is really motivated by other factors:  wanting to have her total body shape reflect how hard she works out, looking good in clothes that make her feel good about herself, and looking the age on the outside that she feels on the inside.

So, instead of the narrow focus of the “Mommy Makeover”, I think what women are really looking for when they consider their options is how they can achieve their Dream Shape.  Seeking this improvement is a natural extension of the commitment so many women already have to looking and feeling their best through healthy living, exercise, skin care and mindfulness.  For some women, the goal may be to improve the shape of their face, adding volume to their cheeks or lips or changing the contour of their neck. For others, their Dream Shape could include a change in the appearance of their breasts, possibly with a lift or a reduction, or adding volume with an implant or fat grafting.  Women may also want to change the look of their waistline, choosing to have a tummy tuck or liposuction or using fat from another area to improve the shape of their buttocks.

In moving beyond the “Mommy Makeover”, women have increased choices to make them feel good about themselves and get them the Dream Shape that really reflects who they are.  To learn more about achieving your Dream Shape, call Dr. Anne Peled at 415-923-3011 or visit www.annepeledmd.com to set up a consultation.

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Can I Get Cancer from My Breast Implants? What We Do and Don’t Know about Breast Implant-Associated Anaplastic Large Cell Lymphoma (BI-ALCL)

The potential association between breast implants and a rare form of cancer was recently brought to light in a New York Times article. Understandably, this has led to a lot of concern from women who already have or who may get breast implants about the safety of their implants. Although the article reports that the breast implants placed in the women featured in the article directly caused their diagnosis of a low-grade lymphoma, there are still many unanswered questions about the causation and the actual risk following breast implant placement.

Here’s what we know about BI-ALCL:

  1. The risk of getting lymphoma following breast implant placement for cosmetic or reconstructive reasons is very low.  Reported lifetime risk in the U.S. ranges from 1 in 30,000 to 1 in 50,000. Hundreds of thousands of breast implants are placed every year, but to-date only 359 cases have been reported from around the world.
  1. BI-ALCL can be treated and cured when discovered early. The typical signs of BI-ALCL are swelling in the breast around the implant after all of the post-surgical swelling has healed (2 or more years after surgery) or a mass in the breast near the implant. If these kinds of symptoms occur, women should be evaluated by their plastic surgeon as soon as possible. Depending on the findings, patients may require imaging of their breast and a possible biopsy or drainage procedure.  Once BI-ALCL has been diagnosed, women will need to undergo surgery to remove the implant and the surrounding capsule as well as any breast masses. Surgery alone is very effective for treating the lymphoma in most patients, though some patients will need chemotherapy or radiation therapy if the disease is more advanced.
  1. Plastic surgery organizations and the FDA are working together to collect more information to better understand BI-ALCL and learn how to prevent it in the future. The American Society of Plastic Surgeons and the American Society for Aesthetic Plastic Surgery in conjunction with the FDA have been actively tracking all cases of BI-ALCL and collecting as much clinical information as possible to try to determine the specific risk factors for BI-ALCL. Research is also being done to investigate genetic and other patient factors that may make patients more susceptible to developing BI-ALCL if they do have breast implants.

Although we do have good information on how to diagnose and treat BI-ALCL, there are still many issues currently being studied about why women get BI-ALCL.  Here’s what we still don’t know about the disease:

  1. What type of implant and what qualities about the implant increase the chance of BI-ALCL. Complete data is not yet available for all of the implants associated with the reported cases of BI-ALCL, so it’s still difficult to make definitive statements about which implants may be more concerning. However, many of the cases have involved implants with texturing on their surface, which is a manufacturing technique that helps implants adhere to the surrounding tissue and is particularly important for shaped (“teardrop”) implants to prevent the implants from rotating the wrong direction when used for breast augmentation or reconstruction. It is not yet clear if implants from certain implant companies are more likely to have associated BI-ALCL or why the texturing might increase the risk, although there are several theories about the potential cause. BI-ALCL has been seen in women with both silicone and saline implants.
  1. Why do certain women develop BI-ALCL while the vast majority of women with breast implants do not develop it. There may be genetic factors that make women more susceptible to BI-ALCL that have not yet been discovered, or women who develop the disease may have higher levels of chronic inflammation around their implants. Further reporting of cases and analysis of the current cases worldwide is needed to better understand the cause of the disease.
  1. How can women who already have implants in place prevent the chance of getting BI-ALCL. As the cause of BI-ALCL is not yet known, there is no specific prevention strategy that women can do, although women should be vigilant about any new concerning symptoms and keep their plastic surgeons informed. Screening for BI-ALCL or removal of implants is not currently recommended or supported by available data.

Additional information can be found on the American Society of Plastic Surgeons’ site on BI-ALCL, which will be updated with newer information as it becomes available.

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Pre-Pectoral Breast Reconstruction

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As breast reconstruction techniques have evolved through the years, patients have benefitted from the advanced technology. One of the latest techniques offering several advantages to patients is breast reconstruction surgery done with what is called pre-pectoral reconstruction.

Pre-pectoral reconstruction places the implant above the chest muscles, which can lead to quicker recovery time, less post-operative pain, and improved mobility. It also prevents hyper-animation deformity, where the pectoral muscles look prominent and can cause a rippling in the implant when they are activated, which can occur when the implant is placed beneath the muscle.

Pre-pectoral reconstruction can be done with either one-stage or two-stage implant reconstruction, which is determined based on patient goals and certain specific details of the treatment plan.

Dr. Anne Peled is a board-certified plastic surgeon specializing in mastectomy and breast reconstruction. For a consultation or for more information, call 415-923-3011 or visit www.annepeledmd.com for more information.

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Dr Peled Speaks at Advances In Breast Cancer Care Luncheon For Breast Reconstruction Awareness Day

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Dr. Anne Peled spoke at the Advances In Breast Cancer Care Luncheon, held October 14th, 2016 at the Yountville Community Center in support of Breast Reconstruction Awareness Day, October 19th, 2016.  The event was sponsored by the St. Helena Martin-O’Neil Cancer Center and also included Dr. Anne Katz, a therapist specializing in breast cancer-related concerns.  The audience included breast cancer care providers, patients and other community members.

Dr. Peled spoke on advances and new directions in breast cancer care.  She addressed some of the latest innovations in breast cancer surgery and oncology to help diagnose and treat breast cancer. Her talk also discussed new and successful techniques in breast reconstruction in order to educate patients about all of their surgical and reconstructive options.  Dr. Peled discussed how to help patients talk with their providers about their surgical plan and if breast reconstruction is right for them.

The Mission of Breast Reconstruction Awareness Day

Breast Reconstruction Awareness Day is a collaboration between the American Society of Plastic Surgeons, The Plastic Surgery Foundation, breast centers, nurse navigators, corporate partners and breast cancer support groups. Breast Reconstruction Awareness Day was founded to educate patients and providers about breast reconstruction options. Informing women of their reconstruction options before or at the time of diagnosis is critically important to improving life after breast cancer.

The American Society of Plastic Surgeons (ASPS) is the largest plastic surgery specialty organization in the world.  Founded in 1931, the society is composed of board-certified plastic surgeons that perform cosmetic and reconstructive surgery.  The mission of ASPS is to advance quality care to plastic surgery patients by encouraging high standards of training, ethics, physician practice and research in plastic surgery. The Society advocates for patient safety, such as requiring its members to operate in accredited surgical facilities that have passed rigorous external review of equipment and staffing.

ASPS works in concert with The Plastic Surgery Foundation (The PSF), founded in 1948, which supports research, international volunteer programs and visiting professor programs. The foundation’s mission is to improve the quality of life of patients through research and development. The PSF accomplishes its mission by providing invaluable support to the research of plastic surgery sciences through a variety of grant programs.

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Dr. Peled Speaks at School of Oncoplastic Surgery

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Dr. Anne Peled was a featured speaker at the School of Oncoplastic Surgery’s September Program in Las Vegas, NV. The program ran September 8-10, and featured experts on Oncologic Surgery speaking to their specialties at Merin Lab at the Medical Education Institute of Nevada.

Dr. Peled’s lecture, Reconstructive Considerations Following Nipple-Sparing Mastectomy, was designed to instruct surgeons how to use different techniques to reconstruct the breast after a mastectomy with nipple skin preservation, which gives the most natural-appearing look following mastectomy.  She also showed other surgeons how to perform various oncoplastic and breast reconstruction procedures through hands-on experience with surgical models.

Oncoplastic surgery uses the latest plastic surgery techniques alongside breast surgical oncology to rearrange the breast tissue at the time of the lumpectomy. If a large lumpectomy will leave the breast distorted, oncoplastic surgery uses the remaining tissue to realign the nipple and areola and sculpt a natural appearance to the breast shape. The other breast will be sculpted to match. The ultimate goal after surgery is to leave no deformity in the breast after surgery and in some cases, make the breasts look better than the did before breast cancer surgery.

These principles are also used in reconstruction after Nipple-Sparing Mastectomy, with the goal of making the breast look as natural as possible with specialized reconstruction techniques.

For more information, or to talk to Dr. Peled about whether oncoplastic reconstructive surgery can help you, visit www.annepeledmd.com or call for an appointment at 415-923-3008 today.

Operating Theater

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What Is Oncoplastic Breast Surgery?

Oncoplastic Surgery

What is “oncoplastic” breast surgery?

Although many patients are aware of breast reconstruction following mastectomy, many do not know about the option of breast reconstruction done at the time of lumpectomy. Oncoplastic surgery is the term used to describe rearranging the breast tissue at the time of lumpectomy to help improve the appearance of the breast after surgery.


What types of procedures can be done for oncoplastic reconstruction?

Reconstruction following lumpectomy can include rearrangement of tissue alone, breast lift, or breast reduction. Breast lift or reduction is also often recommended to be done on the opposite breast as well to improve symmetry after surgery. Learn more about the different oncoplastic reconstruction options HERE.


Are these procedures covered my insurance or are they considered “cosmetic”?

Although every situation needs to be confirmed individually, the State of California (and many others) mandates insurance coverage for any breast reconstruction for cancer, which includes oncoplastic surgery.


What questions should I ask to see if I’m a good candidate for oncoplastic surgery?   

When you meet with your breast cancer surgeon, you should ask if he/she performs oncoplastic surgery or works with a reconstructive surgeon who does.  Studies have shown that the best time to perform oncoplastic reconstruction is at the time of lumpectomy, not at a later surgery, so ask if you can have your reconstruction in the same stage.


Contact our office

For more information about oncoplastic breast surgery or to schedule a consultation with Dr. Peled, please contact our office at 415-923-3008 or complete the online form here.

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Taking Care of Your Breast Health: What You Should Know to Lower Your Breast Cancer Risk

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As a breast cancer surgeon, I’m often asked what women can do to prevent getting breast cancer. Unfortunately, there is no known way to completely prevent breast cancer (yet!), but there are important changes and choices you can make to reduce your chance of getting breast cancer.

1. KNOW YOUR (and your family’s) HISTORY

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Although only an estimated 10 percent of diagnosed breast cancers are hereditary, risk-reducing treatments are available for women with a genetic mutation that puts them at high-risk for breast cancer. Knowing if any of your relatives have been diagnosed with breast cancer or other cancers can help determine if you might be at higher risk and should potentially consider genetic testing.

Other personal factors can also increase your risk for future breast cancer, including if you’ve had any prior history of breast biopsies showing atypical cells or a history of radiation to your chest. You can look at the National Cancer Institute’s Breast Cancer Risk Assessment Tool to learn more about your personal breast cancer risk. If you are at elevated risk, you should consider a referral to a breast cancer specialist to talk about options for reducing your risk.

2. EAT YOUR VEGETABLES (and fruits and fish and nuts)

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Foods full of carotenoids have been shown to reduce breast cancer risk by up to 20 percent. Carotenoids can be found in red-orange fruits and vegetables, leafy greens, and salmon. Try to set a goal of eating a rainbow of colors at every meal for improving not only your breast health, but also your overall health and well-being.

3. BE ACTIVE

Numerous studies in the United States and throughout the world have shown the importance of physical exercise in reducing breast cancer risk. Some studies have shown the risk reduction benefit to be as high as 80 percent! The current recommendation is to have 30 to 60 minutes per day of moderate- to high-intensity physical activity, which can include vigorous walking to yoga to running and everything in between.

4. DRINK IN MODERATION

Although alcohol has been shown to have several health benefits for your heart and blood pressure, increased alcohol consumption has been linked to increased risk of breast cancer. This doesn’t mean you have to stop enjoying an occasional glass of wine or cocktail, just try to limit it to an average of ½ to 1 drink per day over the course of a week.

5. STOP SMOKING

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Smoking has been shown to increase the risk of breast cancer in younger women, as well as cause a number of other health problems. If you’re not currently smoking, definitely do not start! If you are smoking, quitting is one of the best things you can do for your health. The American Lung Association offers a free online smoking cessation program if you want to learn more.

6. GET YOUR MAMMOGRAMS

The current American Cancer Society guidelines for women at average risk for breast cancer are to start yearly screening mammograms at the age of 45 (though based on personal or family history, women may want to consider starting at age 40 or even earlier in some cases). Mammography can help detect breast cancers at earlier stages, which can impact the kinds of treatment required as well as improve survival rates. There is currently a lot of research being done to try to personalize breast cancer screening for women, so ask your doctor about opportunities for new and different breast cancer screening options.

For more information on breast cancer care, please visit www.annepeledmd.com or call us at 415-923-3008 to schedule an appointment.  Our goal is to provide a personalized, thoughtful approach to care that comprehensively addresses all of the components needed to optimize your surgical outcome and your experience through the process.  

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Is Direct-to-Implant Breast Reconstruction Right for Me?

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Is Direct-to-Implant Breast Reconstruction Right for Me?

Common options for breast reconstruction after mastectomy include implant-based reconstruction and autologous reconstruction using a woman’s own tissue.  Traditionally, implant-based reconstruction is done in two-stages, with a temporary implant called a tissue expander placed at the time of mastectomy followed by a second surgery several months later to exchange the expander for a permanent implant.

However, many plastic surgeons are now realizing that selected patients may be able to have one-stage surgery with an implant placed at the time of mastectomy, which is known as direct-to-implant reconstruction or a “One and Done” approach  http://www.cbsnews.com/news/one-and-done-breast-cancer-reconstructive-surgery/.  The benefits of this approach are that women can avoid the need for a second surgery for the exchange and get to their final reconstructive outcome more quickly.

Who are the ideal candidates for direct-to-implant reconstruction?

The best candidates for direct-to-implant reconstruction are women with small-to-medium sized breasts who either want to stay the same breast size or be only slightly larger following reconstruction. Direct-to-implant reconstruction can be done with either nipple-sparing or non-nipple-sparing mastectomies. This approach is ideal in women undergoing prophylactic mastectomies for a genetic mutation or strong family history of breast cancer, though can also be done in women who have breast cancer, depending on their type of cancer and other cancer treatment.

What happens during the surgery and what is the recovery like?

Once the mastectomy and lymph node dissection (if needed) is complete, the permanent implant size is determined and the implant is placed underneath the pectoralis major muscle. A surgical drain is placed in each breast to make sure that fluid doesn’t build up after the surgery. Patients stay overnight in the hospital and typically go home the following day.  Post-op visits usually occur at 1 week and 2 weeks after surgery, with drains coming out at the 2-week visit.  While walking is encouraged immediately after surgery, no heavy lifting or strenuous activity is recommended for at least 4 weeks, with most patients returning to their usual activities and exercise regimens by 6 weeks after surgery.

Contact our office

For more information about breast reconstruction or to schedule a consultation with Dr. Peled, please contact our office at 415-923-3008 or complete the online form here.

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INCREASING AWARENESS ABOUT BREAST RECONSTRUCTION: BRA DAY 2015

b2ap3_thumbnail_BRA-day-photo.jpgFor women diagnosed with cancer, the most important goal for them and their surgical team is and should be to safely treat the cancer and minimize the chance that it comes back in the breast or elsewhere in the body.  Also important, however, is to try to do the operation in a way that gets women back to feeling as good, if not better, about themselves than they did before surgery.

One way to achieve this important goal is through breast reconstruction, which entails re-shaping or re-creating the appearance of the breast following lumpectomy or mastectomy.  Studies have shown that breast reconstruction improves patients’ self-esteem and quality-of-life, as well as body image.   While some geographic areas have high rates of breast reconstruction and good accessibility to plastic surgeons, the rates vary widely across the country, with significant disparities seen across some regions and racial and socio-economic groups showing limited access to breast reconstruction.

To address some of these disparities in access to reconstruction and increase awareness about breast reconstruction options, the American Society of Plastic Surgeons has developed Breast Reconstruction Awareness (BRA) Day, a nationwide celebration occurring every October. Dr. Anne Peled is excited to be a participant in this year’s BRA day program and she and have her staff have been celebrating with several events.

Nike Half Team photoFirst, Dr. Peled ran the Nike Women’s San Francisco Half Marathon with a team from the UCSF Breast Care Center.  She is involved in several research studies through the Breast Care Center to improve outcomes for patients with breast cancer and was excited to be a part of this great team of runners!

Dr. Peled also held an educational event focused on new advances in breast surgery and breast reconstruction for physicians specializing in women’s health.  Through the event she was able to share some of her knowledge and expertise on surgical approaches that help optimize women’s reconstructive results.

Please visit www.annepeledmd.com/ to read more about breast reconstruction or call our office at 415-923-3008 to schedule a consultation with Dr. Peled.

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Dr. Anne Peled is thrilled to be joining Dr. Bryant Toth, renowned aesthetic surgeon

Dr. Anne Peled is thrilled to be joining Dr. Bryant Toth in his Pacific Heights plastic surgery office.  Dr. Toth is an internationally renowned aesthetic and craniofacial surgeon with extensive experience across the spectrum of aesthetic and reconstructive surgery.  Dr. Peled and Dr. Toth share a strong commitment to providing patients with personalized and exceptional care in a supportive and comfortable environment.  Their excellent office staff strives to ensure patients feel completely taken care of from their initial consultation through their final recovery.

For more information or to schedule a consultation with Dr. Peled, call 415-923-3008 or visit www.annepeledmd.com.

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