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.

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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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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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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