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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Genetic Screening: Know Your Risk

Know your risk

Once you’ve spoken with your family members about their cancer history, you should discuss what you’ve learned with your doctor. Depending on your family or personal history of cancer, you may be recommended for genetic counseling or testing. Genetic testing is typically done with either a blood test or saliva test, though it’s best to be informed and discuss the potential outcomes with a trained provider before you undergo testing. If you do end up having a genetic predisposition to breast cancer, a breast specialist can talk to you about the options for screening and prevention, which could include everything from more frequent imaging studies to taking a hormone-blocking medication to considering prophylactic mastectomies. There are many great resources to help you if you do find out you’re at higher risk for breast cancer:

https://ww5.komen.org/BreastCancer/OptionsforWomenatHigherRisk.html

http://www.facingourrisk.org/understanding-brca-and-hboc/index.php

https://www.cancer.org/cancer/breast-cancer/screening-tests-and-early-detection/american-cancer-society-recommendations-for-the-early-detection-of-breast-cancer.html

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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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