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.

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.

PPT

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.

Luncheon

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. 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