Anne Peled Plastic Surgery

Based in San Francisco, Dr. Anne Peled is a surgeon, an educator, a researcher, a mother, an athlete, and a breast cancer survivor. Just a few years into starting her own thriving breast cancer and plastic surgery practice, Anne was diagnosed with breast cancer herself, which gives her the unusual perspective of both the expert and the patient. This has also only strengthened her dedication to provide the most empathic and personal care for her patients, to research and innovate the most cutting edge techniques and practices for breast cancer surgery and reconstruction, and to educate her peers and the public on the best care and prevention for breast cancer and breast health.

What Breast Cancer Survivors Should Know About The FDA's Proposed Breast Implant Warnings

 

Picture1

October 23, 2019

On Wednesday, the FDA asked manufacturers and medical professionals to better inform women about the potential hazards of breast implants. The federal agency has approved saline and silicone gel implants for augmenting breast sizebreast cancer reconstruction, correcting developmental defects, and to “improve: the result of a previous surgery, but implants are not without risks.

“The Food and Drug Administration and the major plastic surgery societies are all working together to do further research more closely looking into implant risks, which will help future patients receiving implants know they’re getting the safest approaches and technologies,” says Anne Peled, MD, a board-certified plastic surgeon practicing aesthetic, reconstructive, and breast oncologic surgery in San Francisco. Although the FDA’s recommendation won’t yet be formally implemented, Dr. Peled says it’s worthy of the attention of doctors, manufacturers, and, most of all, survivors.

In rare cases, people who receive implants may wind up with a form of lymphoma called breast implant-associated anaplastic large cell lymphoma (BIA-ALCL), or a full-body condition called breast implant illness (though this hasn’t been well-studied yet), says Dr. Peled. “More common risks of implants include hardening over time, which is called capsular contracture; infection; rupture or deflation; and malpositioning,” she says. The FDA adds that the longer you’ve had implants, the more likely you are to experience complications.

If you’ve received implants already, Dr. Peled says the FDA news should prompt you to pay attention to the signs and signals your body relays to you.  “Anyone who has had breast implants placed for breast augmentation or reconstruction should see their surgeon once a year to check on their implants. Sooner than that if they develop any new breast signs or symptoms such as swelling, pain, masses, or change in the shape of their breasts,” she says.

Furthermore, if you’re a breast cancer survivor who’s considering reconstructive options, remember that you have choices. “There are a number of reconstructive options available for women who have had both lumpectomy and mastectomy and these can be done not only at the time of breast cancer surgery, but also any time after treatment is complete,” says Dr. Peled. Take the time to speak with your doctor to weigh the pros and cons of the many implants on the market before making whatever decision feels right to you and your body.

Continue reading

Breast Numbness After Surgery Is Too Common. This Surgeon Is Changing That.

 

Picture1

October 22, 2019

In this op-ed, Dr. Anne Peled, MD, a board-certified plastic surgeon practicing aesthetic, reconstructive, and breast cancer surgery in San Francisco, discusses how the prospect of breast numbness after a mastectomy can prevent patients from seeking this life-saving treatment — and how there are new techniques to help preserve sensation.

One out of every eight women and about one out of every 800 men in the U.S. will develop breast cancer in their lifetime, according to the National Cancer Institute. Many people diagnosed with breast cancer opt for a mastectomy, as will many people who know they are at high risk for breast cancer in the future due to their family history or genetic mutations and want to reduce this risk. And while mastectomy is a life-saving measure, few people talk about the after-effects, especially the psychological ones. Through my work as a breast cancer and reconstruction surgeon, as well as having gone through breast cancer treatment personally, the one thing I continue to be struck by is how a mastectomy can negatively affect a person’s sense of self and relationship to their body — and how there are new treatment options to minimize these effects.

At the time of a breast cancer diagnosis, considering treatment options can be very overwhelming. The initial, understandable urge for many people is to just “get the cancer out,” without as much consideration for the potential impact that the treatments may have on them later. Fortunately, we have come a long way in providing many different treatment options for patients. Many breast cancer patients are now offered newer breast reconstruction options and nipple-sparing mastectomy (NSM) approaches, and while these procedures provide excellent aesthetic outcomes, they also unfortunately come with a major downside: loss of breast and chest sensation.

Most people making the decisions around mastectomy don’t realize that the procedure will leave them with little, if any, sensation in their breast or nipple skin after surgery. In one 2018 study, only 2% of women gained full sensation in their breasts after a mastectomy. While this fact is sometimes discussed during surgical consultation, many people are surprised to find out that they have lost sensation after surgery, and are then even more shocked to find out it’s often permanent.

Picture2

It’s difficult to be numb in any part of your body, but breasts may play a big part in a person’s life, from intimacy with their partner, to their sense of femininity. Studies of people who have undergone breast cancer treatment show a significant decline in overall sexual health, with specific studies looking at women who have undergone mastectomy showing it to be associated with a sense of disfigurement and conflict between sense of self and body. I've heard patients voice hesitation or fear about undergoing a life-saving mastectomy because they are concerned about permanently losing feeling in their breasts, and question how that will affect them for the rest of their lives.

When I was diagnosed with breast cancer at age 37 in December 2017, it came as such a huge shock on so many levels, especially as a surgeon who spends every day treating the same disease I’d just been diagnosed with. Once I started thinking about my treatment options, I realized that the thought of losing sensation after a mastectomy, especially so young, played a large role in my decision-making around what type of surgery I chose. I ultimately chose to have a lumpectomy, which is when the tumor is removed with clean tissue around it but the rest of the breast is left intact, primarily to avoid facing a lifetime of chest numbness and the many ways that would impact my life. Fortunately, I had the choice of either lumpectomy or mastectomy based on the size and type of cancer I had, but for many people, mastectomy is the only option. This is especially the case for people with genetic mutations that significantly increase their future breast cancer risk, who are strongly recommended to consider having mastectomies.

From this experience, my husband, Dr. Ziv Peled, who is a peripheral nerve and plastic surgeon, and I began to discuss ways in which we could prevent people undergoing mastectomy from losing sensation after the surgery. We developed a new technique for preserving sensation during mastectomy and implant reconstruction that combines the latest advances in breast oncologic, reconstructive, and peripheral nerve surgery. This procedure introduces the concept of nerve preservation and grafting for restoration of sensation following immediate implant breast reconstruction as a viable option for breast cancer patients.

We have been so excited to see our patients keeping their sensation after mastectomy and implant reconstruction, making it a much more attractive option for people who have been diagnosed with cancer and those who are considering preventive mastectomies, or “previvors.” We hope that as more and more people become aware of the prospect of numbness they will likely face after a mastectomy, breast cancer patients and previvors will seek out the option of sensation-preserving mastectomies, encouraging more surgeons to become trained in these techniques.

We should continue to raise awareness about breast cancer and support these patients who have battled this disease through fundraising, events, and research support. However, it’s equally important to understand the potential long-term impact breast cancer treatment can have on patients. While loss of sensation can be truly daunting, evolving options can help patients move past their breast cancer and continue to thrive.

Studies referenced:

Chirappapha, P., Srichan, P., Lertsithichai, P., Thaweepworadej, P., Sukarayothin, T., Leesombatpaiboon, M., … Kongdan, Y. (2017). Nipple-Areola Complex sensation after nipple sparing mastectomy. The Breast, 32. doi: 10.1016/s0960-9776(17)30390-9

Oberguggenberger, A., Martini, C., Huber, N., Fallowfield, L., Hubalek, M., Daniaux, M., … Meraner, V. (2017). Self-reported sexual health: Breast cancer survivors compared to women from the general population – an observational study. BMC Cancer, 17(1). doi: 10.1186/s12885-017-3580-2

Sun, L., Ang, E., Ang, W. H. D., & Lopez, V. (2017). Losing the breast: A meta-synthesis of the impact in women breast cancer survivors. Psycho-Oncology, 27(2), 376–385. doi: 10.1002/pon.4460

Continue reading

What is A P.A.?

wer

In this video Anne Peled and Nicole Daoud discuss what it means to be a P.A. in 2019.

Continue reading

Breast and Ovarian Cancer Week

HBOC-Week-image

Do you know somebody who has had breast, ovarian or any other hereditary cancers? September 29th - October 5th is Hereditary Breast and Ovarian Cancer (HBOC) week and the entire month of October is Breast Cancer Awareness Month. It’s a good time to remind ourselves what these weeks and month are about and to talk to your family members, friends and healthcare providers about their story and your own history.

In 2010, HBOC made its debut with the goal of raising awareness about hereditary cancers. As we move into Breast Cancer Awareness Month, we are recognizing men and women and all those affected by hereditary breast, ovarian and related cancers including those with BRCA mutations, survivors, previvors, family and friends of those who have been affected by breast, ovarian and related cancer and those with strong family histories of cancer.

Millions of people carry inherited mutations or have strong family history of cancers, but don’t know their individual risk. In some families, breast and ovarian cancer have a predominance to develop and these cancers usually affect woman and men much younger than the average age of diagnosis and some individuals may develop different types of cancers - this is known as HBOC.

Most often, HBOC is caused by inherited gene mutations in the BRCA1 or BRCA2 genes, as well as others. Some families have HBOC based on the predominance of cancer history in their family without a detected gene variant or mutation. Breast and ovarian cancer are very high in women and men with these inherited gene mutations and individuals with strong family history, those of Ashkenazi Jewish descent, and/or family members with HBOC should talk to their healthcare provider about possible genetic counseling to help estimate their lifetime risk of developing these types of cancers. With more knowledge comes more informed decision making and this can guide the discussion with your healthcare provider, gynecologist, breast or plastic surgeon or anyone else involved in your healthcare about what screening tools, guidelines and recommendations that might be right for you and your family. For some women, these recommendations may include increased screening and surveillance, while for others they may include considering prophylactic breast or ovarian surgery.

Know your risk and know what options are available to you. Some resources to find out more are:

cancer.org, HBOC, The Breasties, National Breast Cancer Organization, Anne Peled, MD

Join us throughout the month of October as we celebrate and raise awareness surrounding all those affected by breast, ovarian and related cancers!

Continue reading

Dr Anne Peled Discusses Breast Cancer Surgery in San Francisco

2019-09-23_1412
Dr. Peled was featured on ABC News 7 in San Francisco speaking about performing breast cancer surgery on a breast cancer activist in San Francisco. She discussed the procedure and how a new device called a Biozorb is helping to make a target for radiologists in follow-up procedures. Dr. Peled is on the cutting-edge for breast cancer treatment in San Francisco.
Continue reading

Breast Cancer Advocate Reveals Why BioZorb Was Right for Her

2019-09-23_1412r
Breast Cancer Advocate Reveals Why BioZorb Was Right for Her

Continue reading

Dr. Anne Peled Implant Reconstruction

2019-09-23_1413
Dr. Anne Peled explains the different types of breast implants used in breast implant surgery. Learn more or contact Dr. Peled about breast reconstruction or enhancement surgery today at https://annepeledmd.com
Continue reading

Dr Anne Peled Interviewed About Breast Cancer Awareness Month KTVU FOX2

2019-09-23_1414
Dr Anne Peled Interviewed About Breast Cancer Awareness Month KTVU FOX2
Continue reading

Breast Cancer Surgeon Is 'Shocked' to Learn She Has Breast Cancer — and Then Becomes a Survivor

"I kept reminding myself, 'Remember what you tell your patients,' " Dr. Anne Peled tells PEOPLE

By Wendy Grossman Kantor 
July 26, 2019 01:53 PM
Each product we feature has been independently selected and reviewed by our editorial team. If you make a purchase using the links included, we may earn commission.
GENE COHEN PHOTOGRAPHY

In November 2017, Dr. Anne Peled of San Francisco was taking a shower and doing the monthly self-exam she encourages her patients to do when she felt a lump in her right breast. The now-38-year-old board-certified plastic and breast surgeon told herself it was probably nothing. After all, she’s a super-fit pescatarian, tri-athlete and distance runner, and she has no family history of breast cancer.

But that lump didn’t go away.

On Dec. 7, 2017, she had a biopsy. The next morning, Dr. Peled was preparing to perform a double mastectomy and implant reconstruction on a patient when her phone rang.

“I was getting ready to put on my gloves,” she tells PEOPLE. But she saw her pathologist was calling and answered the phone. “I was sure she was going to tell me it was a cyst and I was going to go on with my day.” 

Instead, the pathologist told the breast cancer surgeon that she had breast cancer herself.

“I was so shocked,” says Dr. Peled. “There were no words. Literally, I tell women breast cancer diagnoses multiple times a week. What I tell all my patients is: ‘This is very treatable. Most breast cancer nowadays — not all — is very curable.’ I kept reminding myself, ‘Remember what you tell your patients.'”

It was a Friday when she received her diagnosis. She immediately began assembling her team. That afternoon she had a breast ultrasound. On Monday, she had a breast MRI.

Dr. Peled’s the type of mom who makes M&M pancakes and regularly piles her three kids and two yellow labs, Kahlua and Clementine, into the car and drives them to the beach or on a hike. “I make my kids go on adventures,” she says. In April, they stayed in a treehouse in Costa Rica.

Husband and wife Dr. Anne Peled and Dr. Ziv Peled, operating on a mutual patient
 
DR. ANNE PELED

But after she was diagnosed with breast cancer, Dr. Peled decided not to tell her young children she had cancer. Her now-8-year-old son Simon, and now-5-year-old twin daughters, Charlotte and Eveline, have friends whose grandparents died of cancer, and she didn’t want them to worry.

Her parents stayed with the children. She scheduled her surgery in Vancouver, Washington, with a surgical team she trusted and would give her the type of hidden-scar surgery she performs herself.

A week later, she came home, told the kids mommy couldn’t lift them because she had “an ouchie,” went back to work and signed up for a 10K.

“By the time I came home, I felt great. And my kids didn’t have any idea that anything had happened,” she says. “In many ways, I look better than how I started, which is pretty amazing.”

The day she learned she didn’t need chemotherapy, she and her husband, fellow surgeon Ziv Peled, toasted with champagne.

“I got really lucky,” she says. “After that first scary phone call, every other piece of information I had after that was great news.”

Dr. Anne Peled with her husband, Dr. Ziv Peled
 
DR. ANNE PELED

Dr. Peled wore her running clothes to her radiation treatments and ran afterwards every day.

“It would clear the space in my head,” she says. “We have really good data that shows that exercise decreases recurrence. I take hormone-blocking pills and I exercise. I think of this as part of my treatment.”

She finished radiation in March and ran the 10K the following month.

Dr. Peled worked with Athleta to design their second https://athleta.gap.com/browse/product.do?pid=869609#pdp-page-content" Empower Bra. She is an incredibly strong and inspirational woman and we are honored to have been able to work with her,” says Casey Schumacher, Athleta’s senior director of design. “Dr. Anne Peled brought invaluable insight, given both her personal and professional experience with breast cancer and reconstruction surgery.” 

Post-cancer bra shopping was something Dr. Peled hadn’t thought too deeply about until she had to do it for herself, she says. Some bras rub where incisions are. “And a lot of women have mobility restrictions, so options of zippers and clasps are important,” she says. “And the fabric — when you get radiation, your skin gets sunburned when you’re healing. So you don’t want the fabric to chafe or rub.”

Once a month, Dr. Peled travels the country to train other surgeons in the type of hidden-scar surgery technique she had herself, because she wants other women to have the “amazing care” that she had. She talks about the technique on social media and invites surgeons to come to her practice to watch and learn the technique.

“Many women don’t realize that not all lumpectomies are the same. A lot of times, there are big scars right over where the cancer was. And then they get closed without reshaping the breast,” she says. “Women get these holes in the breast where your tissue caves in — and that can be pretty disfiguring for women. You wake up in the morning and get out of the shower and you’re reminded every day.”

Dr. Peled wants women to know their options before they have breast cancer surgery.

“I feel lucky to have this job,” she tells PEOPLE. “In so many ways, it’s so scary. It’s so much more filled with hope than it used to be. Our treatments get better and better.

Continue reading

Dr. Peled in Medium - Cancerversary

1_P7FAFP5-vV2JS-Fm6KBDxg

1 P7FAFP5 vV2JS Fm6KBDxg

Dr. Peled shared her Cancerversary story on //medium.com/@annepeledmd/cancerversary-946a5480c51b" target="_blank" rel="noopener" style="box-sizing: border-box; background-color: transparent; color: rgb(47, 47, 47); text-decoration: none !important; transition: all 0.5s ease 0s;">Medium and with Kevin M.D. 

Continue reading

Dr. Anne Peled on ABC

2019-09-23_1414c
 
Dr. Peled was featured on ABC News 7 in San Francisco speaking about performing breast cancer surgery on a breast cancer activist in San Francisco.  She discussed the procedure and how a new device called a Biozorb is helping to make a target for radiologists in follow-up procedures.  Dr. Peled is on the cutting-edge for breast cancer treatment in San Francisco.
Continue reading

Dr. Anne Peled 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/

Continue reading

Dr. Anne Peled on ABC

Dr. Peled's story was featured on ABC 7 in the story Bay Area surgeon views breast cancer treatment from new angle.  Watch and read the whole story here to get more information on Dr. Peled's treatment and how her recovery is progressing.

Continue reading

Dr. Anne Peled in WellAndGood.com

Branded-Feature-1400px-Athleta-CCA-BreastCancer-V2

Anne Peled MD BreastCancer Surgery

Dr. Peled was featured in the story titled "How this one bra could make a difference for breast cancer survivors, according to a cancer surgeon", where she discussed her experiences on both sides of Breast Cancer, as a surgeon that has helped hundreds of patients and as a patient who beat Breast Cancer.  Read the article here to learn more about Dr. Peled's story and the Athleta bra.

Continue reading

Dr. Peled In Medium

Dr_Anne_Peled_In_Medium

 

Dr Anne Peled In Medium

Dr. Peled was interviewed by Yitzi Weiner for his article “I’d Love To Take A Movement Like #Ilooklikeasurgeon One Step Further” With Dr. Anne Peled for Authority magazine.

Continue reading

WHAT I LEARNED FROM SURVIVING THE CANCER I TREAT AS A SURGEON

Screen-Shot-2019-09-06-at-12.22.08-PM

 

No woman can fully comprehend how breast cancer can affect her life until she experiences it personally. As a breast cancer specialist who is also a breast cancer survivor, I can certainly attest to the gap between understanding the disease and battling it firsthand. Unfortunately, I've also found personally and in my practice that a huge repercussion of surgery — emotional and psychological trauma — is chronically overlooked.

While survival is paramount, few consider the emotional impact that accompanies the visible scarring from breast cancer treatment. Many women who undergo breast cancer surgery never fully come to terms with their physical appearance, often having daily reminders of their surgery every time they look in the mirror. The emotional trauma related to incision scars can severely impact a woman's mental health, her feelings of attractiveness and self-confidence, and sexual intimacy and relationships.

A staggering 12 percent of women in the United States will be diagnosed with breast cancer in their lifetime. Although oncologic outcomes from breast cancer treatment continue to improve, the prospect of an altered body image after surgery can be frightening, even with the cancer threat taken away.

I speak from experience, both on a professional and personal level. As a breast cancer and breast reconstruction surgeon, my goal has always been to provide guidance and education about options to help women make the best choice for themselves. I feel so grateful to get to play a role in my patient's lives as they're making these decisions, but definitely never thought I'd be considering these options for myself.

However, in December 2017, following a biopsy of a lump I'd felt on a routine self-check that hadn't gone away, I found myself completely unexpectedly in the role of a breast cancer patient after finding out the lump was invasive breast cancer.

Fortunately, I had caught the cancer early and it was Stage I. I opted for an oncoplastic surgery that would allow for cancer removal and breast reconstruction in the same surgery, so I could wake up cancer-free and also be happy with how I looked, without the daily reminder of what I'd been through.

I'm so glad I made the choice to seek out surgeons who not only cared that my cancer was treated but also how I felt about myself moving forward and the psychological impact of the surgery. Too many women who undergo breast cancer surgery live with the painful reminder of their disease their entire lives, and I so appreciated that they wanted to do everything they could to help me feel and look like myself again.

Successful breast cancer surgery should allow survivors to move past their cancer, and scars play a big role in a woman's ability to do this. Certainly, every woman is different and for some women, even very visible scars can be seen as symbols of victory and strength. But for others, they can be an obstacle, a source of shame, or a painful or disfiguring reminder of their cancer. According to one study, nearly two-thirds of women feel self-conscious about their breast cancer surgery scars, which can have a wide-reaching negative impact on many facets of their lives. I feel so grateful that my scars are well-hidden and my reconstruction was done in a way so that I don't look like I ever had cancer surgery. I know this has a huge impact on allowing me to forget most days that I even had breast cancer.

Surgeons have the responsibility to educate women with breast cancer about scar-minimizing surgery options. The safest, most cost-effective, and patient-centered approach is to thoughtfully and cosmetically place scars and offer breast reconstruction when needed or desired at the time of the initial cancer surgery. This is essential to allow women to move past being breast cancer patients and instead become breast cancer survivors.

When I got diagnosed with breast cancer, I felt so fortunate to have access to exceptional care through my professional connections and the help of my family- my mom, dad, and sister are all breast cancer medical and radiation oncologists. One of the best memories from after my diagnosis was the day I got testing back that showed my cancer was low risk and I wouldn't need chemotherapy: my parents were visiting and I knew when we celebrated with champagne that they truly felt the same relief that I did.

As a physician who does breast cancer and breast reconstruction surgery and research, I was very aware of all my treatment options. But many patients aren't as lucky: one in three survivors say they didn't know about all the surgical options available or even what to expect in terms of scars or breast appearance after surgery, which really limits a woman's ability to feel good about her treatment choice. Recent advances in breast cancer surgery mean that women can have lumpectomies or mastectomies through hidden scars and reconstruction of the cancer site at the same time, which allows them to look the same or sometimes better than they did before surgery.

Dr. Anne Peled is a board-certified plastic surgeon in California who specializes in breast, reconstructive, reduction, and cosmetic surgery. She is uniquely trained as both a plastic surgeon and a breast surgeon and is recognized as a Hidden Scar trained surgeon.

The views expressed in this article are the author's own.​​​​​

Continue reading

#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

Continue reading

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/

Continue reading

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

Continue reading

Why Use Genetic Testing For Breast Cancer Detection

1 smaller

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

Continue reading

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.

Continue reading

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”! 

Continue reading

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.

Continue reading

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

FBLive cover APMD

 

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?

Continue reading

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/

Continue reading

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.

Continue reading

#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?

Continue reading

6TH ANNUAL BRAVE DAY SAN FRANCISCO

IMG 5199

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

Continue reading

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..

Continue reading

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

Continue reading