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.

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

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

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

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Breast Implant Safety: Updates and Resources

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

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

Saline Versus Silicone

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

Textured Versus Smooth

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

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

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

Round Versus Shaped

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

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

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

Implant manufacturer 

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

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

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

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

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

  • BIA-ALCL can be treated and cured when discovered early. The typical signs of BIA-ALCL are late swelling in the breast around the implant (usually 2 or more years after surgery) or a mass in the breast near the implant. If these kinds of symptoms occur, women should be evaluated by their plastic surgeon as soon as possible. Depending on the findings, patients may require imaging of their breast and a possible biopsy or drainage procedure. Once BIA-ALCL has been diagnosed, women will need to undergo surgery to remove the implant and the surrounding capsule as well as any breast masses. Surgery alone is very effective for treating the lymphoma in most patients, though some patients will need chemotherapy or radiation therapy if the disease is more advanced. Death from BIA-ALCL is extremely rare (17 cases reported worldwide) and all occurred after significant delay in diagnosis and treatment and without getting appropriate targeted therapy.

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

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

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

BIA-ALCL

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

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

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

FDA Recommendations

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

Implant Manufacturer Data

https://www.natrelle.com/reconstruction

https://sientra.com/breast-implants

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

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Expanding Patient-Reported Outcomes Tools after Nipple-Sparing Mastectomy

Nipple Sparing Mastectomy

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

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

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

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

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

Ask Dr Anne

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

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

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6TH ANNUAL BRAVE DAY SAN FRANCISCO

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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Welcoming Nicole Daoud, PA-C into our practice!

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

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

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

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

Want to find out more?

Visit www.AAPA.org

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Anne Peled, MD on the Doctors

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

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

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

https://youtu.be/6bhcPpAh0xU

#AskDrAnne #breastcancersurvivor #breastcancerwarrior #breastcancersurgery #thedoctorstvshow

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Getting the Best Breast Cancer Surgery Results

Getting the Best Breast Cancer Surgery Results

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

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

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

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

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

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

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

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Dr. Peled Interviewed in Paige Previvor!

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

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

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

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BREAST AND NIPPLE SENSATION-PRESERVING MASTECTOMY

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

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

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

Learn More Sensation preservation NSM

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Moving Beyond Breast Cancer: Making Room for Revision Surgery

Moving Beyond Breast Cancer: Making Room for Revision Surgery

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

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

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

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Understanding Your Breast Cancer Care Team

Understanding your breast cancer care team

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

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

Radiologist

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

Nurse Navigator

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

Breast Surgeon

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

Plastic Surgeon

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

Medical Oncologist

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

Radiation Oncologist

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

Pathologist

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

Genetic Counselor

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

Primary Care Provider/Gynecologist 

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

Support Services

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

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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 Breast Cancer Surgery

5 Tips for Healing Safely and Smoothly Facebook post

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 afterward. 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 restarting 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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What is Fat Grafting and How Is It Used in Breast Reconstruction?

What is Fat Grafting and How Is It Used in Breast Reconstruction

What is Fat Grafting and How Is It Used in Breast Reconstruction?

What is Fat Grafting?

Over recent years, taking fat from one part of the body and using it to add volume to another part of the body has become increasingly popular.  Fat can now be used to add volume to the face to make it appear more youthful, to the breasts for small breast augmentations, and also for breast reconstruction.  With fat grafting, fat is taken from one part of the body (often the abdomen or thighs) with typical liposuction techniques and then transferred to a different body part. In order for the fat to survive in its new location, the fat has to be carefully processed and put into the new area in small amounts in different layers.  With careful techniques, the majority of the fat that is transferred will "take" and be incorporated into the body.

How is Fat Grafting Used in Breast Reconstruction?

Fat grafting has become an important part of breast reconstruction after mastectomy, both in reconstructions using implants and those using your own tissue (flaps).  Fat grafting can help add more volume or projection to reconstructions, it can also help to camouflage irregularities or give a more natural appearance to the breast.  Fat grafting can also be used in women who have had lumpectomies in the past and have noticeable divots at their lumpectomy site.

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Anne Peled M.D. Discusses Oncoplastic Surgery's Benefits

Anne Peled MD Oncoplastic Surgery 30 Sec Moment

Anne Peled M.D. discusses how Oncoplastic Surgery can have a positive effect on the lives of breast cancer reconstruction patients during Breast Cancer Awareness Month. For more information about Oncoplastic Surgery, visit https://annepeledmd.com today.

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What Is Oncoplastic Surgery?

What Is Oncoplastic Breast 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 the 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 reconstruction. 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 By 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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Pre-Pectoral Implant Reconstruction

Pre Pectoral Breast Reconstruction Title Card

Prepectoral ( or "above-the-muscle") breast reconstruction is an innovative, less invasive, breast reconstruction approach with quicker recovery, less pain, and better outcomes than older approaches that place implants under the muscle.  In this approach, implants are covered with a skin substitute that helps protect the implant and reduces the chance of hardening around the implant in the future.  With prepectoral reconstruction, the chest wall muscle is not cut or disturbed in any way, so recovery is faster and there's less chance of long-term chest wall pain.  Prepectoral reconstruction also completely eliminates a problem frequently seen with under-the-muscle reconstruction called "hyperanimation", where rippling of the muscle and movement of the implant is visible with flexing of the chest muscles.  Prepectoral reconstruction can often be combined with nipple-sparing mastectomy and one-stage implant reconstruction, which gives natural results and gets women back to their lives and activities more quickly and smoothly.

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How to Choose Your Breast Surgeon

Surgical team pic

After finding out you need surgery, the next step is to find the right surgical team for you, which can feel stressful and overwhelming, especially after a new breast cancer diagnosis.  Here are some suggestions for finding your breast surgery team:

Seek out a breast surgery specialist: 

Breast cancer treatment is constantly evolving and you want a surgeon who is up-to-date on all of the latest treatments to get you the best care.  Fellowship-trained breast surgeons have specialized training in all of the different aspects of breast cancer care to help guide you towards the right overall treatment plan for you.  Breast surgery specialists also understand the importance of performing surgery in a way that hides scars and minimizes the visible effects of the surgery to help you move past your surgery without a constant reminder.

Ask to see examples of your surgeon's results:

To help you get a better sense of how you might look after your surgery, your breast reconstruction surgeon can show you examples of how other patients have healed after similar surgery.  You can also ask your surgeon about what kind of complications might happen after surgery and how often these complications happen in their practice. The goal from initial meetings with your potential surgical team is to help you have the best sense of what to expect after surgery, including how you might look and feel, and what your outcome would likely be.

Find someone who answers all your questions:

The best way to feel comfortable going into surgery is to feel like your surgeon will be there to help you through your recovery.  In choosing a surgeon, you should feel like you can ask her or him any question that will help you understand the surgical process better and make the best choice for you. 

Look for a board-certified surgeon: 

In order to know your surgeon has gone through rigorous review of her or his patient outcomes and demonstrated safe patient care, look for a surgeon that is board-eligible or board-certified by the American Board of Surgery (breast surgeons) or the American Board of Plastic Surgery (reconstructive surgeons).

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