Dual perspective: Plastic surgeon shares lessons learned after her

Plastic surgeon shares lessons learned after her cancer diagnosis

When Anne Peled, MD, a San Francisco-based plastic and breast cancer surgeon, discovered a lump in her breast during a routine self-

exam at age 37, she never suspected breast cancer. Dr. Peled had no family history of the disease. She lived a healthy lifestyle and exercised often. She presumed the lump was a cyst until a biopsy revealed stage 1 breast cancer. Although Dr. Peled frequently informed women of their diagnosis and treatment options, she found herself unexpectedly facing breast cancer through the lens of a patient.

Dr. Peled weighed her options carefully. The cancer had not spread, and she didn’t need chemotherapy. After receiving negative genetictesting results for breast cancer gene mutations, she reached out to a trusted plastic surgeon and colleague in Vancouver, Wash., to schedule a lumpectomy with oncoplastic reconstruction, a breast-conserving technique that only removes a portion of the breast and reshapes a woman’s breast using her own tissue. Dr. Peled credits her surgical team for her optimal aesthetic outcome by using the hidden-scar approach she performs on her patients.

“I felt very strongly about not wanting a visible reminder of cancer every day, so I’m grateful to my surgeon for his surgical scar management,” she says. “As a plastic surgeon, I’m always thinking about what recovery looks like and how we can get people back to their lives quickly and safely –

By Kendra Y. Mims

Left: Anne Peled, MD, before surgery. Above: Dr. Peled and husband Ziv Peled, MD, in the operating room.

whether it’s cosmetic or reconstructive surgery. I thought about that for my own recovery, and I had a team that helped me think through my options and supported my decision. I was comfortable with my treatment plan and felt it would be less invasive and obtrusive to my life.”

A year after the initial diagnosis, Dr. Peled says she will need alternating mammograms and MRIs every six months for most of her life. She is also required to take estrogen-blocking medication for five years, but she has no regrets about her decision. As an avid runner and triathlete, Dr. Peled says choosing a procedure that preserved most of the appearance and sensation of her breast weighed heavily in the decision-making process.

“Women tend to lose all sensation in their chest area after a mastectomy, which can really negatively impact their lives,” she says, recalling her friend’s inability to feel anything while trying on bras after a mastectomy.

“When weighing my options, I had to consider how each surgery would impact my ability to exercise and get back into my active work and home life,” she says.

One of the main benefits of oncoplastic reconstruction done at the time of lumpectomy is using your own tissue to reshape your breast, which maintains sensation and a natural feel to your breast tissue.

“We can make some women’s breasts look better than they did before surgery with a breast lift or reduction done in conjunction with lumpectomy,” she adds. “This option

Even though I do breast cancer surgery and reconstruction day in and day out, I still had a hard time figuring out the best choice for me in terms of surgical options. I try to help women weigh different options and identify what’s going to be the right choice for them in a much more involved way than I did before.

could be less invasive than a full mastectomy and reconstruction. We have a full spectrum of choices, so women can find what option is best for them. Every woman is different.”

Building deeper connections

Dr. Peled’s practice in the Bay Area specializes in reconstructive and breast cancer surgery. As a dual-trained plastic surgeon and breast cancer surgeon, she is involved in her patients’ breast cancer care from diagnosis to surgical treatment. She says her own diagnosis changed her interaction with patients, allowing her to connect with them on a much deeper level – and she believes she’s a better plastic surgeon for it.

“Being able to know what it feels like to hear you have breast cancer firsthand really changes your ability to empathize and help women think through their treatment options,” she says. “Even though I do breast cancer surgery and reconstruction day in and day out, I still had a hard time figuring out the best choice for me in terms of surgical options. I try to help women weigh different options and identify what’s going to be the right choice for them in a much more involved way than I did before.”

After being on the receiving end of waiting for test results, Dr. Peled now prioritizes getting patients their results quickly to avoid the waiting game, even if it means calling after hours or during the weekend. She also notes her new understanding of the family’s vital role throughout treatment.

“I didn’t realize the depth of this until I went through it, and now I’m much more attuned to think about how women talk to their significant others and children about their diagnosis and how they can assemble their support system,” Dr. Peled says. “That’s been an extremely valuable part of this, because I feel the relationships with my patients are so much richer and stronger than they were before I was diagnosed myself.”

It takes a village

Dr. Peled attributes her passion for treating breast cancer patients to her family of physicians. Her parents and sister are all oncologists specializing in breast cancer, and they stayed by

The Peled Family

her side during treatment. Dr. Peled says her family’s medical expertise and support were instrumental in helping her through recovery.

“They were so helpful in getting me different resources,” she says, adding her parents’ work inspired her to become involved in cancer research in high school. “For a long time, I’ve witnessed how rewarding it’s been for my parents to help people navigate through the incredibly disruptive and scary time around a cancer diagnosis and get them to the other side where they can feel back to themselves and return to their lives. I feel so incredibly grateful to be a part of my patients’ lives in the same way.”

Although Dr. Peled maintained an open dialogue about her cancer journey with her family, she chose not to discuss her diagnosis with her then 6-year-old son and 3-year-old twin daughters. She maintained her regular routine, so they didn’t suspect anything.

“My kids were so little, and I didn’t want to worry them,” she says. “Fortunately, I recovered quickly from my surgery. I worked the entire time, so my kids didn’t know any different. In their eyes, I was just their mom doing all the things I had done before, so their lives weren’t too impacted. I was grateful for that.”

Dr. Peled also had a tremendous amount of support from her husband, Ziv Peled, MD, who is also a plastic surgeon. Dr. Peled, who now operates alongside her husband to perform sensation-preserving mastectomies with nerve grafting to improve sensation for women after mastectomy, notes that being married to a plastic surgeon required a balancing act of discussing and involving him in her treatment without being overwhelming.

“My husband specializes in migraine headache surgery, but he’s done enough breast reconstruction over the years to a recurrence, and it’s something I prescribe to my patients as well.”

Exercising after radiation treatments kept Dr. Peled feeling mentally strong through her journey.

be understandably concerned,” she says. “Trying to figure out how to share my expertise and knowledge about breast cancer so that he felt involved without worrying him was a real balance we both had to work on.”

Healing benefits of exercise

Dr. Peled wore running clothes to radiation therapy and ran after every treatment. She also ran a 10K several weeks after completing radiation. She credits exercise for keeping her mentally strong, and she strongly advises women to see a physical therapist and begin an exercise program after their breast cancer surgery.

“Exercise often gets overlooked for many women as part of their healing, but it plays a huge role in breast cancer treatment, most importantly in decreasing the chance of cancer returning,” Dr. Peled says. “Working out has so many psychological benefits, as well as managing side effects after surgery and other treatments including hormone blocking therapy, chemotherapy and radiation. Running helped me feel more like myself instead of someone going through cancer treatment. Exercise is part of my treatment now to help prevent

Words of wisdom

Dr. Peled currently travels the country throughout the year to teach surgeons how to perform oncoplastic surgery on their patients. Although this procedure was the best option for her, she urges women to do their homework to find the right procedure and board-certified plastic surgeon for them and to talk to other women about their experience.

Dr. Peled implemented a buddy system in her practice that pairs women who have undergone breast cancer surgery with women considering it. She says it helps for them to hear about the procedure’s impact on their job, exercise or family and adds that patients are pleasantly surprised to learn that most breast cancer today is survivable, and the recovery is less extensive than they expected.

“Researching your options and talking to others will help you make a much more informed decision,” Dr. Peled says. “Often, women hear they have cancer and just want to get it out without really considering their options, which is understandable. Sometimes I bring up the idea of breast reconstruction or hiding scars and women think of it as cosmetic, but it’s not. It’s really about not thinking of yourself as a cancer patient every day once you’ve gotten through all of your treatment and have settled back into your pre-cancer life.

“I tell my patients, ‘My hope is you're going to have these breasts for a very long time, and I want them to be something you are happy with,’ ” she continues. “I don’t want them to have the reminder of cancer. It’s a big deal when a woman can look in the mirror after breast cancer and feel like herself again or even better than when she started her journey.”