Anne Peled Plastic Surgery

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.

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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Dr. Anne Peled Interviewed About Breast Cancer Awareness Month

The Journey Outwards

Dr. Anne Peled was interviewed on KTVU about Breast Cancer Awareness Month to discuss both her experience with breast cancer and how she treats it at her practice. Watch the entire video here, and if you have questions about breast cancer surgery or breast cancer awareness, visit www.annepeledmd.com today to make an appointment or read more.

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Exercising after Plastic Surgery: 5 Tips for Healing Safely and Smoothly

Exercising after Plastic Surgery 5 Tips for Healing Safely and Smoothly

One of the most frequent questions I get asked when I speak to patients about recovering after surgery is when they can exercise again. I love having active and healthy patients and strongly encourage exercise before and after surgery, but always spend a lot of time going over an exercise timeline to make sure it’s done safely. While you should ask your surgeon what his/her protocol is for exercising after surgery, here’s what I recommend:

1. Think of getting ready for surgery like training for a race or athletic event. The better shape you are going into surgery, the better shape you’ll be coming out of it. Having more muscle mass before surgery can help speed up the time it takes for swelling to go away afterwards. And for certain procedures, such as tummy tucks, strengthening your core muscles before surgery can make it easier to get back into core exercises once you’re able to do them again after surgery.

2. Figure out what kind of special exercise gear you’re going to need for exercising after surgery and buy it before surgery so you’re ready. Depending on what type of surgery you’re having, you may be recommended to have compression garments or wear special types of bras. If you have whatever your surgeon has recommended at home in advance, as soon as you get the green light to exercise, you’ll be ready to start.

3. Consider re-starting your exercise program with the help of a physical therapist or personal trainer. Even if you’ve carefully reviewed your exercise plan with your plastic surgeon, it can still often be helpful to enlist the help of an exercise professional for when you re-start. They may notice alignment or technique issues that they can point out to you to help your exercise be safer, or may be able to give you specific stretching or strengthening exercises based on the type of surgery you had. I personally refer almost all of my patients to physical therapy after surgery and many of them feel like they end up even stronger than they started thanks to their physical therapy.

4. Listen to your body. It seems obvious, but you know your body best. If a certain exercise is painful, or just doesn’t feel right, stop and ask your surgeon or physical therapist/personal trainer about it and make sure you’re not negatively impacting your surgical healing. Also, if you notice any concerning changes in your incisions or surgery site, contact your plastic surgeon to check in.

5. Set goals, but be flexible with your schedule and yourself. On a personal level, exercise is an incredibly important part of my life, both physically and psychologically, and I couldn’t wait to go back to it as soon as possible after my own surgery. I think for people who are used to being active, setting goals for yourself about getting back into your exercise program can make you feel better about and more in control of your recovery. But just remember that if you do have to slow things down because healing takes longer than expected or something doesn’t feel great, try to just accept it as part of taking care of yourself and being safe, rather than as a major setback- you’ll get back on track to your goals before you know it!

To discuss your surgical options or make an appointment, visit www.annepeledmd.com or call the office at 415-923-3011.  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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Considering Prophylactic Mastectomy? Knowing Your Options Can Help You Get the Best Outcome

Prophylactic Mastectomy

Prophylactic Mastectomy is a surgical procedure that removes one or both breasts in order to lower the potential for breast cancer development in women at higher breast cancer risk.  The surgery can significantly reduce the risk for women carrying the BRCA1 or BRCA 2 gene mutation or other gene mutations, as well as women with a strong history of breast cancer in their family. 

Prophylactic mastectomy can nearly always be done as a nipple-sparing mastectomy, which gives women the psychological and visible benefit of preserving their own nipples.  It also saves them from having to have additional procedures in the future for nipple reconstruction.

Depending on a woman’s goals, breast reconstruction can be done as either a one-stage or a two-stage procedure with either implants or using their own tissue.  Newer techniques for implant reconstruction include one-stage, above-the-muscle reconstruction, which allows women to avoid having a tissue expander and helps them recover more quickly.  Flap procedures such as DIEP flap reconstruction preserve a woman’s abdominal muscles, again helping them recover more quickly with fewer long-term issues.

To discuss your surgical options or make an appointment, visit www.annepeledmd.com or call the office at 415-923-3011.  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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Dr. Peled Profiled in the CSPS New Member Spotlight

Dr. Peled has been chosen to be profiled in this month's California Society of Plastic Surgeons New Member Spotlight, with an interview discussing the best thing about being a plastic surgeon, her favorite procedure to perform, what she couldn't operate without, her first social media check in the morning, her favorite hobby, and the best part of what next weekend will be.  It's a great profile!

You can read the profile on the California Society of Plastic Surgeons' site at https://californiaplasticsurgeons.org/csps-new-member-spotlight/ and learn some more about Dr. Anne Peled, the leader in breast cancer surgery, breast reconstruction surgery, and all mastectomy and reconstructive surgeries, including nipple-sparing reconstruction and immediate pre-pectoral implant reconstruction, two procedures that help women make quicker recoveries and wake up looking as good or better than when they underwent the surgery.

CSPS NEW MEMBER SPOTLIGHT

In 2018, the CSPS welcomed 10 New CSPS Active Members.  We are excited to highlight our newest members of the CSPS – this week, we are pleased to shine the spotlight on:

Dr. Anne Peled

The best thing about being a Plastic Surgeon is: The challenge and immense satisfaction of doing something truly and often immediately transformative for patients, whether it’s reconstructive or aesthetic surgery.  I love the “unveiling” at the initial post-operative visit, when patients get to see their results for the first time- it’s by far one of my favorite parts of being a plastic surgeon.

My favorite procedure to perform is:  Nipple-sparing mastectomy and immediate pre-pectoral implant reconstruction- I love being able to offer a procedure where women with breast cancer or at high risk for breast cancer wake up from having mastectomies looking essentially the same, or even better, than they did when they started.

I couldn’t operate without my:  Fun socks or hot pink OR glasses.  As much fun as it is to have a job where you get to go to work basically in pajamas, on my OR days I like to wear something in bright colors too- my patients often make comments about my socks when I’m in doing their markings before surgery.

Dr. Peled in the OR wearing her hot pink OR glasses.

The first social media outlet I check every morning is: Instagram. I keep a fairly small number of friends and family and some lifestyle/fitness sites (like Athleta and Self Magazine) that I follow, so I don’t get overwhelmed looking through them. I love starting my day with little photographic glimpses into everyone’s lives mixed in with style inspiration and fitness routines!

My favorite hobby is: Anything that gets me outside being active- running, triathlons, stand-up paddling boarding, hiking.  Even 30 minutes helps me clear my head from the day and gets me feeling great for the next one.

Dr. Anne Peled along with her husband, Dr. Ziv Peled (also a CSPS member)

The best part of next weekend will be: Taking my family to Legoland (in Carlsbad, CA) – all 3 of my kids (7 year-old son and 4 year-old twin daughters) have been asking me and my husband pretty much every week when we can go back since our last visit there!

The Peled family enjoying some quality time at Lego Land!

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21st Century Breast Reconstruction: Less Invasive, Better Outcomes

I recently saw a woman in my office who had been diagnosed with breast cancer over 30 years ago, at age 37.  At that time, she had undergone a simple mastectomy without reconstruction, a major lymph node dissection, and chemotherapy for what sounded like a small, very treatable, Stage I cancer.   Since that time, as would be expected, her non-cancer breast had gotten larger and dropped over time, and as a result of the major asymmetry between the two sides of her chest, she had mostly been wearing hoodies or loose-fitted patterned sweaters for years to try to hide her chest.  She had also developed neck and shoulder pain as a result of the lopsided-ness of her chest and found that even trying to wear a mastectomy bra and prosthesis wouldn’t fix her asymmetry in clothes and her pain.  She had been living like this for 30 years, without knowing her asymmetry could be significantly improved with an insurance-covered reconstructive surgery.

I was so struck by how things had changed over 30 years between her treatment and mine after my recent breast cancer diagnosis at the same age she had been.  With a small, Stage I cancer, women like me have the option of avoiding major lymph node surgery and can instead have just a few lymph nodes removed, saving them from potential complications such as long-term arm weakness or swelling. With the development of genomic tumor testing, women can get information tailored specifically to them that can help them make informed decisions as to whether or not they would benefit from invasive treatments such as chemotherapy.

And finally, on the reconstructive side, there have been so many advances that truly improve how women look, feel, and recover after breast cancer surgery.  Most women now have the less invasive option of breast-conserving surgery, which can be combined with a number of different reconstructive techniques (“oncoplastic surgery”) that avoid future divots at the lumpectomy sites and can in some cases lift or reduce the breasts in a way that makes them look even better than before surgery.   For women having mastectomies, they can now often have nipple-sparing mastectomies, giving them the psychological and aesthetic benefit of keeping the external appearance of their breasts.  When combined with less invasive types of reconstruction such as over-the-muscle (“pre-pectoral”) implant reconstruction, women can be back to their normal lives in a matter of weeks with natural looking breasts.

For all of us who treat women with breast cancer, or have had breast cancer ourselves, we’re so fortunate to benefit from the advances of the past 30 years and to eagerly await the advances coming in the next 30.

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Pre-Pectoral Breast Reconstruction

Switching to pre-pectoral (“over-the-muscle”) breast reconstruction: how to fix chest wall hyperanimation

Up until the last few years, most women who had implant reconstruction after mastectomy typically had their implants placed under their chest wall muscles.  Now, however, we know that women can get great reconstruction results with implants placed over the chest wall and covered with a soft tissue supportive matrix such as AllodermÒ.  The benefits of this approach are more natural looking results, less chest wall pain, and most importantly, complete elimination of “hyperanimation deformity”, which is the appearance of the muscle and implant moving up with chest movement that many women with implants under the muscle experience.

For women who have hyperanimation after implant reconstruction below the muscle, here are some answers to help you think about how best to fix it:

How does switching to pre-pectoral reconstruction help with hyperanimation?

Switching the implant from under- to over-the-muscle involves freeing up the chest wall muscle from the overlying breast skin and sewing it back in place to its normal position on the chest wall.  By doing this, when the chest wall contracts, it is no longer visible because the implant and the soft tissue supportive matrix are now sitting underneath the breast skin and in front of the chest wall muscle. Studies show that 100% of women who have their implant switched to the over-the-muscle position have their hyperanimation fixed.

What is the recovery like after the surgery?

Because the new implants are placed over the muscle, women have little discomfort from the surgery and can go home the same day.  Typically drains are placed during the surgery and removed around 10 days to two weeks.  Once the drains are out, women are free to go back to most of their normal activities and can be back to full exercising by four weeks after surgery.

Is this surgery covered by insurance?

Because this is a reconstructive surgery, insurance companies are required to cover the procedure.

What are the potential downsides to switching to over-the-muscle reconstruction?

When implants are placed over the muscle, they can sometimes be more visible or easier to feel in the upper part of the breast, depending on how much soft tissue coverage women have in that area following their mastectomy.  A good way of addressing this is to do fat grafting at the time of the surgery, where fat is transferred from one part of the body (usually the abdomen or thighs) and then placed into the breast to help camouflage the edge of the implant.

To discuss if this surgery may be helpful for you, please call Dr. Peled at 415-923-3011 or e-mail at This email address is being protected from spambots. You need JavaScript enabled to view it..

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BRAVE Day 2018

Today is the 5th Annual BRAVE Day for Breast Reconstruction, and I am so proud to be part of the event to help raise awareness.  BRAVE Day is sponsored by the BRAVE Coalition, and their mission is to create awareness for women’s rights to a Breast Reconstruction after Breast Cancer Surgery.  While it’s a law that insurance carriers cover breast reconstruction after surgery, a majority of women are not told about or given this option.  This is unacceptable.

 Less than 30% of women actually know about their legal restoration options, and that has to change.

That’s why we are proud to stand with the BRAVE Coalition every day and want to raise awareness here on BRAVE Day to help every woman who has been misled about their rights.

To donate, visit https://www.bravecoalition.org/donate-now/ and please like their page at https://www.facebook.com/BraveCoalitionorg-296161687107707/ to learn more. 

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Dr. Peled Quoted in Cosmopolitan

Dr. Peled was quoted in Cosmopolitan this week in an anticle titled Facts About Inverted Nipples. 

You can read the article here and learn more about inverted nipples and what they mean for your body.

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Dr. Peled Featured in The Columbian

 

Dr. Anne Peled's story has been featured in the Columbian.  Please follow the link to read the well-written article by @MarissaHarshman.  

http://www.columbian.com/news/2018/jan/22/breast-cancer-surgeon-diagnosed-with-breast-cancer-advocates-oncoplastic-surgery/

 

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When a Breast Cancer Surgeon Gets Breast Cancer: Being on the Other Side of the Scalpel

Six weeks ago, I was diagnosed with invasive breast cancer.

 

As a breast cancer and breast plastic surgeon, I see women all the time who are in the exact same place I’ve been since receiving the phone call from the pathologist.  Shocked and terrified by the news, overwhelmed by what this is going to mean for their life in both the short- and the long-term, waiting for results from what seems like endless tests that could significantly change their treatment options. When talking about my practice, I would tell people that my goal was to provide the kind of personalized, high-touch care that I would want to have if I were in my patients’ position - I never imagined I’d actually be needing that kind of care myself, though. 

So far the journey has been, and I know will continue to be, an unpredictable course of emotional highs and lows, buoyed by great testing news one day only to be followed by an evening where I can’t stop tearing up every time I hug my three young kids.  I really never understood until now that the discussion I have with my patients about surgical choices for breast cancer in so many ways isn’t about choices at all; it’s really about picking what seems like the better of two non-ideal options for a disease you certainly didn’t choose to get and that will be a part of you in some way for the rest of your life.  

I truly believe these options can get better, that we can come up with new techniques and technologies that continue to give women great cancer outcomes but do an even better job at minimizing the impact on their previously scheduled, pre-cancer lives.  Approaches that don’t take away from their feelings of self; leave them feeling as close to “normal” as possible; allow them to maintain their jobs, family life, exercise routines, and personal relationships without compromise following surgery.   As I’ve struggled with my own surgical “choices” over the past six weeks, I know that these better options can’t come soon enough.  

As I write this, I am days away from having a lumpectomy, sentinel lymph node biopsy and oncoplastic breast reconstruction. As a surgeon, in many ways this part of my treatment feels the most predictable, as it is mostly reassuring (though also at times terrifying) to know exactly what all the steps of my procedure will be, a replica of an operation I’ve done many times.  But I’ve been struck in the past weeks by how every time I pick up the scalpel to start an operation, I have a brief moment of the recognition that I’m soon going to be on the other side of the scalpel, in an unfamiliar and vulnerable position completely in the hands of my (fortunately amazing) surgical team.  I was humbled before by all of the patients who put a similar trust in me to be their surgeon, but now truly understanding what it’s like to be entirely in someone else’s hands, especially in the midst of all of the anxiety after being diagnosed with cancer, has transformed that feeling into sheer gratitude. So as I head into my own surgery, I take that deep feeling of gratitude with me - gratitude for the women who trust me to do operations to cure their breast cancer, for the surgeons who are going to cure me of mine, for the family and friends who have shown me more love than I ever could have imagined, and for the sparkling hope I hold so strongly in my heart that we are one day going to completely transform breast cancer care.

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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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