Anne Peled

#TeamPeled Study on Sensation Preservation after Mastectomy and Implant Reconstruction Published in “Plastic and Reconstructive Surgery – Global Open”

unnamed #TeamPeled Study on Sensation Preservation after Mastectomy and Implant Reconstruction Published in “Plastic and Reconstructive Surgery – Global Open”

 

We are excited to have the results from our combined work on nerve grafting and preservation at the time of nipple-sparing mastectomy and implant reconstruction published in the open access arm of the largest international plastic surgery journal. The study describes our combined work to improve sensation for women who go through mastectomies and implant reconstruction for breast cancer or breast cancer risk-reduction. While other plastic surgeons have previously published studies looking at nerve grafting for breast reconstruction sensation with free flaps using women’s abdominal tissue for reconstruction, this is the first published study doing nerve grafting for women having implant reconstruction. This is important because many women either are not good candidates for flap reconstruction or would prefer not to have the additional recovery and surgical site required for flap reconstruction. Additionally, not all reconstructive surgeons routinely perform flap reconstruction, and thus the vast majority of women who have breast reconstruction have implants used.

Our study included both women having nipple-sparing mastectomies for cancer treatment and women having prophylactic mastectomies for genetic mutations or strong family history. We found that with carefully preserving breast skin nerves and doing nerve grafting to the nipples, most of the women in our study had close to complete return of breast skin sensation and feeling in their nipples after surgery.

To Read Full Article Click Here

For more information on this novel procedure, please contact our office at:
TEL: 1-415-923-3011
Email: This email address is being protected from spambots. You need JavaScript enabled to view it.

ANNEPELEDMD.COM

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Considering a breast reduction?

breast-reduction Considering a breast reduction?

 

A breast reduction, also known as a reduction mammaplasty, is a surgery where breast tissue and skin are removed to reduce the size of the breasts while also re-shaping and lifting them. This surgery can not only help to alleviate some of the symptoms associated with large breasts such as back, neck, and breast pain, but also lead to a more youthful looking breast shape and size. •

Most women who seek a breast reduction usually have a few things in common. The following issues are often described by women who might benefit from breast reduction surgery:   

        • You feel as if your breasts are too large or disproportional to your body frame 

  • • Your breasts are heavy and pendulous and your areola and/or nipples point downwards or seem much lower on your chest than you would like

  • • You have disproportionate breast sizes, where one breast is much larger than the other breast

  • • You have neck, back, upper shoulder, or breast pain secondary to your large or heavy breasts

  • • You have chronic skin infections/irritation to the skin underneath your breasts

  • • You find it difficult to exercise due to your large breast size (or feel the need to wear multiple sports bras to give you the support while exercising) or have trouble finding clothes or bras that fit you

If these symptoms resonate with you, the first step in seeing if you are a good candidate would be to either discuss this with your primary care provider or find a board-certified plastic surgeon in your area and set up a consultation.  At that visit, your plastic surgeon will determine if it would be safe and appropriate to recommend a breast reduction for you.  If it is, your plastic surgeon will then send your consultation note documenting how much breast tissue he/she thinks would be removed during your surgery to get you to the size you'd like to be and clinical photographs to your insurance company for insurance authorization. For the most part, when women have significant disruptions in activities of daily living as a result of their large and heavy breasts, insurance companies will cover this surgery, though every company is different.

Once you have decided to proceed with breast reduction surgery, your surgeon will discuss the best options for you in terms of incision and technique for the surgery. We like to show patients 3D simulations of what they might look like after a breast reduction using their own photographs, which helps women have a clear sense of what their goals are.

The surgery itself typically takes from three to four hours, is done under general anesthesia (where you are put to sleep with medicine) and it is almost always outpatient surgery (meaning that you get to go home the same day of your surgery). Women tend to do very well after this surgery and may be uncomfortable for the first 24-48 hours, but usually have good pain control with ibuprofen and potentially some stronger pain medication for breakthrough pain if needed in the first week or so.

Recovery after the surgery varies on a multitude of factors, but in general, one week off work or school is expected. Your surgeon will likely have you wear a sports bra for quite some time before transitioning to a regular bra (without underwire for the first three to six months). It is normal to feel like your breasts are heavy and tight – this is from swelling; however, it may take several months for your breasts to settle in and complete healing takes about one year. Most women feel like they can return to normal life activities within two weeks after surgery and are back to full exercise by 4 to 6 weeks.

 

Breast reduction surgery can be truly life-changing for many women, which is why it’s one of our favorite surgeries to offer! Please contact our office with any additional questions to help decide if breast reduction surgery could be helpful for you.

To Learn More Visit http://www.annepeledmd.com/

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Breast surgeon becomes breast cancer survivor

bc Breast surgeon becomes breast cancer survivor

In a touching interview, breast surgeon Dr. Anne Peled opens about her personal experience as a breast cancer survivor

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Why Use Genetic Testing For Breast Cancer Detection

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Dr. Peled explains how women need to use Genetic Testing to determine if they are at risk for breast cancer in her new video.

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Wondering about Textured Breast Implants?

Textured Implants

After recent increased concerns around breast implant safety, which prompted an FDA hearing in March 2019 focused on this issue, certain types of breast implants and tissue expanders with textured surfaces have now been taken off the market.

Here’s some information that may help you sort through your breast implant-related questions and be able to make an informed decision about options.

Does this decision affect all breast implants?

No, this is specifically regarding textured implants and expanders (not smooth ones) from only one of the implant manufacturers, Allergan. Both saline and silicone implants come in smooth and textured surfaces, but the vast majority of implants placed in the United States are smooth.

What is the concern with textured implants?

The main concern and the reason these implants have been taken off the market has to do with a rare type of lymphoma that has been linked to breast implants with textured surfaces. Depending on the implant type, rates of this type of lymphoma (called BI-ALCL) range from 1 in 3,000 to 1 in 30,000. Although there have unfortunately been a small number of deaths from this lymphoma, it is usually very treatable when identified early.

Is removal of already placed textured implants being recommended?

No, right now there is not a recommendation from any government agency or plastic surgery society to remove textured implants (even ones from Allergan, which have the highest rates of lymphoma with their textured implants). However, patients with any type of implants, textured or smooth, should follow-up with their plastic surgeon (or another board-certified plastic surgeon) for a check of their implants every year or sooner if they develop any new pain, swelling, or change in appearance or feel of their implants.

If you have had breast implants placed already by Dr. Peled, please feel free to contact our office at 415-923-3011 with any questions about your implant type or the safety of your implants, and visit annepeledmd.com to learn more.

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Outcomes Utilizing Inspira Implants in Primary Aesthetic and Reconstructive Surgery

Outcomes Utilizing Inspira Implants in Primary Aesthetic and Reconstructive Surgery

I recently had an article published in Plastic and Reconstructive Surgery  about using silicone implants for breast reconstruction and breast augmentation.  One of my favorite parts about being a plastic surgeon is getting to use and learn about new technology, which is why I was excited to talk about the latest advances in silicone breast implants for this article. With the most recent generation of silicone implants (“gummy” implants), the silicone is more cohesive, which means that the silicone stays together better, with less concern that the silicone will rupture and potentially spread. It also means that they hold their shape and projection better when placed in the breast, which is particularly important for breast reconstruction when the breast tissue is no longer there to provide shape. One misconception about “gummy” implants is that they are very firm, but actually they can feel fairly soft and natural in the body, even with the increased “gumminess”! 

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What To Expect After Breast Cancer Surgery

What To Expect After Breast Cancer Surgery

In the midst of processing everything after finding out you have breast cancer, thinking about what to expect after surgery can easily get lost. While everyone’s recovery is a little different, and it’s always best to check with your surgeon about their specific recommendations, here’s an overview of common breast cancer procedures to give you a sense of what they might be like:

Lumpectomy

This is usually done as an outpatient surgery, often under lighter anesthesia. Typically recovery is about a week, with return to sfull activity within two weeks. If a lymph node biopsy is done at the same time, I often recommend not lifting the arm on that side completely overhead for 2 weeks, as well as working with a physical therapist after surgery to help with stretching and strengthening exercises. No special bras are needed after this surgery, though soft bras that don’t rub are helpful to use during radiation if you need radiation.

Breast lift/reduction for lumpectomy reconstruction

When combined with lumpectomy, breast reductions or lifts are still typically done as outpatient surgeries, though sometimes an overnight stay is recommended. Most surgeons do not use drains, but some may use them and recommend they stay in for a few days or longer. Recovery is usually around two weeks, with light exercise encouraged by the end of the first week and a return to full activity usually by four weeks. Physical therapy is helpful for recovery and to help with swelling. A soft bra that zips or clasps in the front that provides some compression should be worn full-time for 2 weeks, and then during the day for another 2 weeks. I recommend avoiding underwire bras for 3 months to decrease the chance of irritation at incision sites.

Mastectomy (with or without reconstruction)

The expectations for after this surgery really depend on whether or not reconstruction is done and the type of reconstruction. Surgery typically entails at least an overnight stay, though it may be more like 3 or 4 days if flap reconstruction is done. Drains are used and usually stay in place for 10 to 14 days depending on the type of reconstruction. Once drains are out, I recommend physical therapy to help with chest opening exercises and strengthening.  Return to activity varies, but is usually from two to six weeks depending on reconstruction. Similar to breast reductions, a soft bra that zips or clasps in the front can be helpful for the first few months to provide support and a little compression. Underwire bras should be avoided for 3 months.

To learn more about Lumpectomy, Breast Lifts/Reconstructions and Mastectomies, visit annepeledmd.com today to make an appointment to talk with Anne.

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#AskDrAnne Anne Peled, M.D. Answers Your Breast Cancer Surgery Questions April 19, 2019

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Anne Peled, M.D. answered many patients' questions about Breast Cancer Surgery and Breast Health on April 19, 2019.  We collected the questions below so you can watch the video and find answers to all of these questions at the times listed below:

2:20 How many women who choose to save their nipples end up getting cancer anyway, either if they have mastectomies for prophylactic or for cancer reasons?
3:25 Some surgeons are worried about the risk of necrosis after nipple sparing mastectomies, meaning that nipples might have healing problems or that some of the nipple tissue might not survive. How likely is this?
4:15 What should I expect from a recovery standpoint, after prophylactic mastectomies or mastectomies for cancer?
7:00 If I have large breasts, a small frame and a limited ability to use my own tissue, what are my reconstruction options?
8:20 Can gummy implants deflate?
10:05 How do I choose implant size?
11:30 Have you ever seen redness at the incision site, where the wound isn't infected?
12:50 How soon can I travel after breast reconstruction surgery?

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Breast Implant Safety: Updates and Resources

Wondering about the safety of your breast implants_.jpg

Concerns about the safety of breast implants have been all over the news lately, but the information presented is often confusing and can lead to more questions than answers. In order to really understand all of the information, it’s important to know some basics about breast implants (which many women are unfortunately not well-informed about before having implants placed!).

First, here are the main features of breast implants that impact their safety and outcomes:

Saline Versus Silicone

Breast implants can be filled with either silicone or saline, though both have a silicone shell on the outside of whichever fill type they have inside the shell. There are potential benefits and downsides to both- the most commonly described advantages of silicone are that they feel more natural and have less rippling, while some women prefer saline because of the ease of identifying rupture if it happens and greater overall peace of mind with saline implants.

Textured Versus Smooth

The surface texture of an implant refers to properties of the silicone shell and basically comes in two types, “textured” (which has a rough surface that acts like Velcro with the surrounding tissue) and “smooth” (which has a completely flat surface that doesn’t interact with the surrounding tissue in a significant way).

The major benefit of textured implants is that the “Velcro effect” can hold implants in place better, which can allow surgeons to use shaped (“teardrop”) implants without worrying that they’ll rotate in the wrong orientation in the implant pocket, and also that the breast shape after augmentation or reconstruction with implants may be stable for a longer time because of the contact between the tissue and the implant.

Implant companies have different “levels” of texturing, which are designed to optimize patient outcomes but also appear to impact the risk of a rare form of lymphoma called Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL- see below for more information).

Round Versus Shaped

Implants come in two different shapes, round and shaped (also known as “teardrop”). Round implants can have smooth or textured surfaces, while shaped implants need to have a textured surface to prevent the rotation issue described above.

Prior to finding out about the link between implant texture and BIA-ALCL (see below for more information), decisions around implant shape were entirely related to patient goals for their breast/reconstructed breast appearance, but now concerns around texturing have led many surgeons to recommend smooth implants exclusively, and thus fewer shaped implants are being used (at least in the U.S.) 

Within the different implant shapes there are also different levels of projection and implant width and height, which also impact the overall look to the breast after augmentation or reconstruction, but don’t impact the safety profile.

Implant manufacturer 

There are a small number of breast implant manufacturers in the U.S., and all have different proprietary processes for how they make their implants, which can affect their long-term outcomes as well as potential risks from the implants. All of the implant companies collect data on outcomes with their own implants, but there are really not any great studies comparing different implant types to each other.

Surgeons usually have specific reasons for using a particular implant type, and some many use more than one type, so it’s good to ask why your surgeon prefers one type over the other and how they make their choices.

After you have breast implants placed, you should receive an implant card that contains all of the information listed above (although depending on the manufacturer or age of your implants, you may have to look up your implant type to find out about the shape and texturing). If you don’t still have the card (or never received one), your plastic surgeon’s office should be able to give you a copy.

Next, here’s what we know and don’t know about breast implant safety and BIA-ALCL as of this publication date (April 2019):

  • The risk of getting lymphoma following breast implant placement for cosmetic or reconstructive reasons is very low. Reported lifetime risk in the U.S. for women with textured implants ranges from 1 in 3,800 to 1 in 30,000. Hundreds of thousands of breast implants are placed every year, but to-date only 457 unique cases have been reported to the FDA.

  • BIA-ALCL can be treated and cured when discovered early. The typical signs of BIA-ALCL are late swelling in the breast around the implant (usually 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 BIA-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. Death from BIA-ALCL is extremely rare (17 cases reported worldwide) and all occurred after significant delay in diagnosis and treatment and without getting appropriate targeted therapy.

  • Plastic surgery organizations, implant manufacturers, 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, as well as implant manufacturers, have been actively working in conjunction with the FDA (including a recent two-day hearing) to track all cases of BIA-ALCL and collecting as much clinical information as possible to try to determine the specific risk factors for BIA-ALCL and the safest implant options for women. Research is also being done to investigate genetic and other patient factors that may make patients more susceptible to developing BIA-ALCL if they do have breast implants.

  • There have not been any recommendations from any plastic surgery organization or the FDA for asymptomatic women who currently have breast implants to have them removed. The current recommendations for monitoring implants include regular imaging (current guidelines recommend MRI, but this may be changed to ultrasound) and routine follow-up with your plastic surgeon. I recommend yearly follow-up for all of my patients with breast implants, with earlier follow-up if any new breast symptoms such as pain, swelling, change in breast appearance, breast masses, or implant firmness develop.

Finally, here are some resources by topic that can help as you’re making decisions about implants or wondering about the risks of implants if you already have them:

BIA-ALCL

https://www.plasticsurgery.org/for-medical-professionals/health-policy/bia-alcl-physician-resources

https://www.plasticsurgery.org/documents/Health-Policy/ALCL/ALCL-Brochure-Trifold.pdf

https://www.mdanderson.org/cancer-types/implant-associated-anaplastic-large-cell-lymphoma.html

FDA Recommendations

https://www.fda.gov/medicaldevices/productsandmedicalprocedures/implantsandprosthetics/breastimplants/ucm239995.htm

Implant Manufacturer Data

https://www.natrelle.com/reconstruction

https://sientra.com/breast-implants

https://www.breastimplantsbymentor.com/breast-implants/

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Expanding Patient-Reported Outcomes Tools after Nipple-Sparing Mastectomy

Nipple Sparing Mastectomy

I’m honored to have recently had a paper published in Plastic and Reconstructive Surgery  focused on patient-reported outcomes after nipple-sparing mastectomy and breast reconstruction. Over the past decade, plastic surgeons have realized the importance of not just reporting on complication rates after surgical procedures, but also specifically focusing on how patients feel about their surgery, or “patient-reported outcomes”. For this study I was lucky enough to collaborate with some experts in the field of patient-reported outcomes, including Dr. Andrea Pusic, who is the lead developer of a patient-reported outcomes tool called the BREAST-Q. The BREAST-Q has become widely adopted in breast surgery research and is thought of as the gold standard for assessing patient-reported outcomes after a variety of breast surgery procedures.

Prior to our research study, the BREAST-Q hadn’t yet included questions specifically related to nipple-sparing mastectomy (NSM) in regards to NSM scars, nipple sensation, or nipple appearance. The goal of our study was to speak to women who had undergone NSM and immediate reconstruction, as well as health care providers treating women after NSM, to come up with and validate survey questions that could help to better understand how women feel about these outcomes. Following the validation of these questions in our study, the questions can now be incorporated into the BREAST-Q to help surgeons improve their techniques and get women better outcomes.

As my husband Dr. Ziv Peled and I move forward with our innovations in mastectomy and reconstruction techniques to allow women to have breast and nipple sensation after NSM and implant reconstruction, we’re excited to have better patient-reported outcomes tools like the more comprehensive BREAST-Q survey to help us really understand our results and continue to innovate further.

For more information on Nipple Sparing Mastectomy and Breast Cancer Surgery, visit www.annepeledmd.com or call our office at 415-923-3011 to make an appointment.

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#AskDrAnne Anne Peled, M.D. Answers Your Breast Cancer Surgery Questions

Ask Dr Anne

Anne Peled, M.D. answered many patients' questions about Breast Cancer Surgery and Breast Health on March 27, 2019.  We collected the questions below so you can watch the video and find answers to all of these questions at the times listed below:

0:49 Over the muscle or under the muscle reconstruction: can you muscle be too thin for over the muscle reconstruction?
1:42 Is over the muscle less safe from a cancer perspective?
2:35 What are the downside for going over the muscle?
3:47 Under the muscle: can it cause chronic neck and back pain and does this get better when you switch this?
5:06 What is your opinion about the implant illness we keep seeing articles about?
6:23 For over the muscle reconstruction, how do you choose between expanders or implants?
7:29 What are some of the factors to consider with nipple-sparing mastectomy and how can sensation be preserved?
9:24 Who is a candidate for a nipple-sparing mastectomy?
11:11 What should I expect during recovery from these procedures (over the muscle implants, nipple-sparing mastectomy)?
13:20 What exercises do you recommend to help recovery?
14:48 Is breast reconstruction covered by insurance?
16:08 How safe are implants?

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6TH ANNUAL BRAVE DAY SAN FRANCISCO

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ANNE PELED, M.D. JOINS BRAVE COALITION FOUNDATION IN CELEBRATING THE 6TH ANNUAL BRAVE DAY, EDUCATING AND ADVOCATING FOR BREAST CANCER RECONSTRUCTIVE RIGHTS

[SAN FRANCISCO, CA] March 21, 2019 Breast Restoration AdVocacy and Education (BRAVE) Coalition Foundation is recognizing their 6th annual “Brave Day” nationally this year.  Brave seeks to empower women through educating them of their rights to reconstruction when diagnosed with Breast Cancer. BRAVE is about restoring the whole woman after the diagnosis, and is one of few charities that focuses on “after the diagnosis.”  

March 21st is National Breast “Restoration” Day - a day that we encourage everyone to spread the word that women have the right to reconstruction after breast cancer treatment. Although 1 in 8 women will be diagnosed with breast cancer, only 30% of those diagnosed know their federally mandated right to reconstruction. In order for breast cancer survivors to thrive, BRAVE Coalition promotes that all survivors should be empowered with education and resources to give them the choice and opportunity to experience life beyond cancer as her whole self, however she defines it.

BRAVE Day will be celebrated nationally at multiple locations across the United States.

"At the time BRAVE was founded, there wasn’t a nonprofit that focused attention on breast restoration also referred to as reconstruction,” says Christine Grogan, MHA/EMHL, Founder “BRAVE was started to help women know of their options after breast cancer removal so there could be a positive focus during the next phase of their journey.  We call it “restoration” since the end result is women restored to their best self, however they choose.”  

About BRAVE Coalition Foundation
The Breast Restoration AdVocacy and Education (BRAVE) Coalition Foundation, a 501(c)3 nonprofit, was founded in 2013 by Christine Grogan, industry leader in breast restoration rights awareness, to promote education and awareness of resources for breast cancer survivors regarding breast reconstruction options.

To find out how to get involved with BRAVE, www.bravecoalition.org

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Considering Prophylactic Mastectomy? How to Help Make the Best Decision for Yourself

 Considering Prophylactic Mastectomy How to Help Make the Best Decision for Yourself

Finding out you’re at increased risk for future breast cancer due to your family history or a genetic mutation (or both), can be really overwhelming. Here are some steps that may help you come up with a plan that feels right to you and lets you feel more in control of your health and body.

First, a genetic counselor and/or high-risk breast specialist can help you really understand your risk of breast cancer and any other cancers that you might have to think about. They can talk to you about screening and prevention plans, which could range from more frequent imaging studies and exams to considering taking hormone-blocking medication or prophylactic mastectomy.

Knowing what your surveillance plan looks like can help you make a decision about if and when you want to think about having prophylactic mastectomies.

Next, if at all possible, find a surgeon who specializes in breast surgery and routinely does mastectomies.  Nearly all women having prophylactic mastectomies are candidates for nipple-sparing mastectomies if they would like to save their nipples, which has been shown in multiple studies to be safe in women at high risk for breast cancer due to family history or genetic mutations.

Depending on your breast shape, size, and goals, nipple-sparing mastectomy might involve an initial breast reduction or lift to make NSM safe at the next surgery. Your breast surgeon can also help connect you to a plastic surgeon if you’re considering breast reconstruction. Keep in mind that there are many different techniques for different types of reconstruction, so take your time asking potential plastic surgeons about the trade-offs of the different procedures and feel free to get multiple opinions if needed to help you feel most informed.

I find one of the most helpful things for making the decision around prophylactic mastectomies is talking with other women who have gone through it. In our office, we are lucky enough to have prior patients who are willing to speak with women considering mastectomy about their experiences, which we offer to coordinate for all of our new patients.

We try to match them with other women who may have similar health or personal situations that could play a role in their recovery - we think of it like a buddy system! There are also some great groups that have fostered communities of women sharing and supporting women through their journey- a couple of our favorites are The Breasties and FORCE.

We’d be happy to see you in the office or via Skype call if you’d like to learn more as you’re considering your options. Please contact us at (415)923-3011 or This email address is being protected from spambots. You need JavaScript enabled to view it..

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Welcoming Nicole Daoud, PA-C into our practice!

Nicole Daoud 500x625We are so excited to have welcomed Nicole Daoud, PA-C, into our practice in late 2018. Nicole is bright, energetic, compassionate, and really goes above and beyond to help provide the patient-centered, high-touch care we are so proud of at APMD. As a patient in our practice, you may see Nicole when you come in for your first consultation, at a follow-up or pre-operative visit, or when you come back to the office after surgery.  

Wondering what a PA is?   PAs, or Physician Assistants, are medical providers who diagnose illness, develop & manage treatment plans, prescribe medications, and often serve as a patient’s principal healthcare professional. With thousands of hours of medical training, PAs are versatile and collaborative. PAs practice in every state and in every medical setting and specialty, improving healthcare access and quality.

To obtain a license, PAs must graduate from an accredited PA program and pass a national certification exam. To maintain their certification, PAs must complete 100 hours of continuing medical education (CME every two years) and pass a re-certification exam every 10 years. PA's practice in every healthcare work setting and in every specialty.

What's the difference between a PA and a Nurse Practitioner? Both PAs and nurse practitioners (NPs) play an increasingly vital role as front-line healthcare providers. Although there are some significant differences in training and maintenance of certification requirements, the similarities between PAs and NPs far outweigh the differences. What is important for patients to know is that, regardless of whether they see a PA or an NP, they are being treated by a highly educated, well-trained healthcare provider who places the patient at the center of their care.

Want to find out more?

Visit www.AAPA.org

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Anne Peled, MD on the Doctors

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If you missed Anne Peled, MD on The Doctors TV today, click below to hear Anne share how she got through her own breast cancer diagnosis and what it has meant for her practice.

This Friday, Anne will host a Facebook Live to answer any questions about her own breast cancer experience, breast health, screening considerations, and reconstruction options.

You can ask us questions during the Facebook Live chat or, if you can't be there live, send your questions to us at https://annepeledmd.com/ask-dr-anne and we will try to answer your question during the stream.
We're looking forward to seeing you there!

https://youtu.be/6bhcPpAh0xU

#AskDrAnne #breastcancersurvivor #breastcancerwarrior #breastcancersurgery #thedoctorstvshow

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Getting the Best Breast Cancer Surgery Results

Getting the Best Breast Cancer Surgery Results

One of the most rewarding parts of my job is educating other surgeons and patients on new and exciting techniques in breast cancer and breast reconstruction surgery. I love interacting with surgeons who are truly passionate about learning new approaches to help their patients get better outcomes, and with patients who want to know all of their options to make the best decisions. I often hear from women, though, that they didn’t know what to ask their surgeons to make sure they were getting access to the most innovative, patient-centered care and that they regretted not getting second opinions or researching more before having their surgery. 

Given the psychological and emotional issues that understandably come up when thinking about having breast cancer or reconstruction surgery, women deserve to have a surgeon who is really focused on getting them the best outcome that minimizes the negative impact on their bodies, both short- and long-term, and is least disruptive to their sense of self and body image. Here are a few suggestions to help make sure you’re getting this kind of patient-focused breast surgical care:

1) Ask about where your scars will be. Lumpectomies and mastectomies can often be done in ways where the scars are hidden so you don’t have a constant reminder of your breast cancer or breast surgery.

2) Ask to see before and after pictures of other women who’ve had a similar surgery to what you’re planning. This can help show you where scars will be and what they’ll look like and give you a realistic sense of how you might look after surgery. It also helps you evaluate your surgeon’s results and lets you compare outcomes between surgeons.

3) Consider a second opinion. Different surgeons have different skills and it can be useful to hear more than one recommendation as you’re making your decision. It can also just be helpful to have information presented multiple times so that you really understand your options.

4) Ask if you can speak with other women in the surgeon’s practice who have had the same surgery that you’re considering. This will help you learn more about what to expect and how patients feel about their results. Keep in mind, though, that every woman’s experience is different, so add what you hear from other women who’ve been through it to information from your surgeon and other resources to help you make the best decision.

For more information or to make an appointment to see Dr. Peled, visit annepeledmd.com or call us at 415-923-3011.

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Dr. Peled Interviewed in Paige Previvor!

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I was interviewed last week for the article "Choosing Between Over or Under the Muscle" by Paige More over at paigeprevivor.com.  Paige asked me a variety of questions, ranging from my experiences as a survivor of breast cancer to my opinion on Over the Muscle and Under the Muscle breast reconstruction techniques.

Paige had a double mastectomy 2 years ago at 24 and has been blogging at https://paigeprevivor.com about her experiences and sharing her story to help other women who may need help or have questions about breast cancer and breast cancer surgery, including our topic, whether to go over or under the muscle for implant breast reconstruction.  She is also co-founder of the amazing group The Breasties, which supports young women affected by breast or ovarian cancer.

Our interview covers all sorts of different questions about breast reconstruction, from recovery to screening. If you have any questions about implant reconstruction or switching from under the muscle to over the muscle, give us a call to schedule an appointment to learn more!

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BREAST AND NIPPLE SENSATION-PRESERVING MASTECTOMY

One of the most common operations performed for the treatment of breast cancer is a complete mastectomy, which involves removal of all of the breast tissue.  Mastectomy approaches have evolved over time and many women are now able to safely have nipple-sparing mastectomies in the hands of well-trained breast surgeons.  When combined with immediate breast reconstruction, women can have outcomes where their breasts look the same, or even better, than they did before their mastectomy. However, despite the significantly improved cosmetic outcomes in breast reconstruction with these techniques, most women don’t realize that they will have little if any, sensation in their breast skin or nipple skin after surgery.

Because of the way the nerves to the breast skin and nipple travel through the breast tissue, traditional mastectomies tend to cut through these nerves, which leads to breast skin and nipple numbness for many women, or even sometimes, painful sensations at the cut nerve ends.  To try to prevent this numbness or pain, our team (Dr. Anne Peled, breast oncology and reconstructive surgeon, and Dr. Ziv Peled, peripheral nerve and plastic surgeon) have been doing sensation-preserving mastectomies, where we either carefully preserve the nerves during nipple-sparing mastectomies and/or do nerve grafting if nerves cannot be preserved safely.  We have already done a number of these mastectomies combined with immediate implant reconstruction and most women are telling us that their breasts feel almost the same or exactly the same as they did before surgery!

We are so excited to be able to offer this innovative new approach for women considering mastectomy for breast cancer treatment or breast cancer prevention.  Please contact us at 415-923-3011 to learn more.

Learn More Sensation preservation NSM

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Moving Beyond Breast Cancer: Making Room for Revision Surgery

Moving Beyond Breast Cancer: Making Room for Revision Surgery

I’m currently only weeks away from my one year “cancerversary” from being diagnosed with Stage I breast cancer at age 37 and am finding myself taken back to where I was last year in getting ready to be on the “other side of the scalpel” as I prepare for reconstruction revision surgery. In some ways, this feels similar, in terms of the worry about complications, how my recovery’s going to go, and the impact it will have on my family, work, and exercise routines. But in so many other ways, this time is different, and complicated in ways I never expected, despite having performed so many breast reconstruction revision surgeries myself as a plastic surgeon.

While my first surgery was overwhelming because of all of the cancer unknowns, like whether or not my lymph nodes were involved and if I’d need chemotherapy, this time feels “elective”, which brings a new set of emotions with it. When I reassure my patients that their initial or revision breast reconstruction surgery will be covered by insurance because it’s not their choice to have breast cancer or a gene putting them at high risk for breast cancer, I like to think it gives them permission to truly accept the surgery as reconstructive, and not cosmetic (which it of course isn’t). And even though I completely believe this for myself as well, somehow it still leaves me wondering if going through surgery again is something I really “need” to do. I’m cancer-free and honestly have a pretty fantastic result thanks to my amazing surgical team, which makes me question if I should just ignore the subtle divots and asymmetries left from my cancer treatment instead of going through another surgery? Is it worth it to put myself and my family through another recovery when I’m truly grateful every day to feel so healthy and am completely settled back into all of my pre-cancer exercise and work routines?

And then, in the midst of all of this doubt, I remember what I promise my patients, which is that I will do everything I can to get them back to feeling and looking like themselves after surgery as quickly and smoothly as possible so that they’re not reminded every day when they look in the mirror that they had cancer. I think about how happy it makes me when one of my patients says that they can barely remember which side they had cancer on because they’ve healed so well or that they like their breasts even more than they did before their cancer surgery thanks to their oncoplastic breast reconstruction. And it reminds me that I too deserve to look in the mirror every day without a reminder of cancer and to head into my revision surgery with the permission to look as healthy and cancer-free as I feel.

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Understanding Your Breast Cancer Care Team

Understanding your breast cancer care team

Finding out you have breast cancer can be overwhelming on so many levels. In the midst of all of the initial appointments, it can be difficult to understand which providers you need to see and how each one is involved in your care.

Here are some of the breast cancer providers who may be a part of your breast cancer care team (everyone’s situation is a little different, so you may not need all of them):

Radiologist

For many women, a radiologist is the first doctor they meet with, usually to review an abnormal mammogram or ultrasound and to perform a breast needle biopsy. Depending on your follow-up plan, radiologists will likely be a part of your ongoing care after your breast cancer treatment as well, continuing to evaluate any follow-up mammograms, ultrasounds, or MRIs you may have.  

Nurse Navigator

Not all centers have nurse navigators, but in the ones that do, they play a huge role in helping women get through finding out about their diagnosis and coordinating their care. Nurse navigators will often set up appointments for patients to meet with a surgeon or a medical oncologist and provide information on important resources and support services.

Breast Surgeon

Meeting with a breast surgeon is usually your first appointment after finding out you have breast cancer. Your breast surgeon will talk to you about surgical options and discuss any other tests you might need before surgery. After surgery, they will review your pathology results with you and the next steps in treatment.

Plastic Surgeon

All women diagnosed with breast cancer should get the opportunity to meet with a plastic surgeon to discuss their reconstructive options.  Some breast surgeons may be able to do some types of reconstruction (such as lumpectomy reconstruction) on their own and some women may choose not to have reconstruction, but hearing about the options can help you make the most informed choices.

Medical Oncologist

Most women with invasive cancer and some women with non-invasive cancer/pre-cancer will see a medical oncologist as part of their treatment. Medical oncologists prescribe pills and IV-medications (such as immunotherapy or chemotherapy) to treat breast cancers or prevent them from coming back after they’ve been removed.

Radiation Oncologist

Radiation oncologists typically meet with women after their breast cancer surgery to discuss using targeted radiation to help prevent breast cancer from coming back after surgery. Most women having lumpectomies will be recommended to see a radiation oncologist, while only some women having mastectomies will be recommended to have a radiation oncology visit.

Pathologist

Although you likely won’t ever meet a pathologist during your breast cancer treatment, pathologists play an important role in your care.  They review the tissue taken during your breast biopsy and breast surgery to determine specific details about your breast cancer, which helps determine your breast cancer treatment.

Genetic Counselor

Depending on your family history, as well as your personal history and age when you’re diagnosed, you may be recommended to see a genetic counselor.  Genetic counselors will review your history and may talk to you about undergoing testing to check for a genetic cause for your breast cancer.

Primary Care Provider/Gynecologist 

Your primary care provider, whether an internist or gynecologist or other provider, is an important part of your breast cancer team.  They may help you to get in to see breast cancer specialists when you’re first diagnosed.  They will also be involved in following you after you finish your treatment, which may include doing breast exams or ordering follow-up imaging tests.

Support Services

There are many other care providers who may be a part of your team, including physical therapists, nutritionists, social workers, and psychologists, among others.  All of these providers will help get you through your treatment as smoothly and healthily as possible and may play an important role during and after your breast cancer journey.

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