Everviolet Chats: Dr. Anne Peled, MD, Plastic, Reconstructive & Breast Surgeon
When it comes to finding the right doctor to help us on our cancer journey, wouldn't it be incredible to find one who's actually experienced it firsthand? Meet Dr. Anne Peled, MD – a Plastic, Reconstructive and Breast Surgeon and Co-Director of the Breast Cancer Center of Excellence at Sutter Health California Pacific Medical Center in San Francisco – who is not only one of the most pioneering surgeons in the country but a breast cancer survivor herself. We were honored to be able to sit down with Anne and discuss both aspects of the medical field in our most recent Everviolet Chats. To discover what initially inspired her to become a surgeon, the medical techniques she specializes in as well as how being on the patient side of breast cancer changed her role as a physician, read on.
What inspired you to become a breast surgeon?
My parents are both breast cancer providers (my mom is a radiation oncologist and my dad is a medical oncologist), so I got involved early on with oncology research and care. My first internship was as an art therapy intern in the pediatric oncology clinic in high school, and I have loved being a part of taking care of patients going through cancer journeys ever since.
One of the reasons I was drawn to breast surgery is the unique challenge and satisfaction in not only helping treat women’s cancer, but also helping them feel and look like themselves again after treatment, ideally getting them even better than they were before their diagnosis.
Are there certain surgical techniques you recommend or prefer over others? How do you help your patients determine the best reconstruction type for them?
I feel so lucky to be a breast cancer and reconstruction surgeon at a time when we have so many good surgical options. Every woman’s goals and situation are different, and learning about what makes the options different, from the surgery itself to the recovery to the long-term results, really helps women make the best choice for them.
Please describe the procedure you and your husband developed to help women retain sensation following breast surgery? How extensively are you performing it?
When I was diagnosed with breast cancer myself at 37, I really struggled with what kind of surgery to have. I knew that many (probably most) young women in my situation would choose to have mastectomies. But in conversations with friends and patients who had gone through mastectomies, it seemed so daunting to think about the very real likelihood of having my chest be completely numb from that point forward. I chose to have a lumpectomy and oncoplastic reconstruction instead and have been very happy with the choice, but the whole experience led me and my husband (who is a plastic surgeon specializing in peripheral nerve surgery) to think about what we could do to make mastectomies better. Starting in February 2018, 1 month after my surgery, we started doing nipple-sparing mastectomy surgeries together, carefully working to identify and preserve all of the nerves that could be safely preserved and then using nerve grafts to help provide sensation to the nipples. While not all women are candidates for nerve grafting, everyone can benefit from nerve preservation, and we’ve found that around 90% of our patients get back sensation throughout their skin and nipples after mastectomy and implant reconstruction, which we’re so excited about.
You were already a breast surgeon when you were diagnosed with stage 1 breast cancer. Can you share a little bit about your personal experience? How did you discover the cancer? What treatment/surgery did you opt for?
When I felt a breast lump during a self-exam in November 2017, I assumed it was going to be a cyst – I had no family history of breast cancer, I was only 37, and I ate healthily and exercised often, so I didn’t even consider that it might be cancer. When it hadn’t gone away after a couple of weeks, I had it biopsied and was shocked to find out it was invasive cancer. I carefully considered all of my options and eventually decided on lumpectomy and oncoplastic reconstruction followed by radiation therapy. Based on genomic testing of my tumor, I didn’t need chemotherapy and have been on Tamoxifen since I finished my radiation. Fortunately, my recovery from the initial surgery and a small revision surgery I had later, as well as radiation, went really well, and I feel completely back to my pre-cancer life at this point.
How has your experience as a patient changed your role as a surgeon? Have your professional goals changed since then?
I understand the complexity of medical decision-making so much more now, as well as how disruptive cancer is on your life after your diagnosis and in the following months/years during treatment. Before my diagnosis, I was really committed to doing everything I could to support women through their journey and get them safely and smoothly through surgery, but now I feel even more strongly how important it is to try to provide holistic care to truly allow women to recover on all levels.
In your opinion, what is the future of medicine, specifically as it relates to breast cancer?
One of the most exciting aspects of breast cancer care right now is the focus on personalized cancer treatment to each individual woman. There is a heightened awareness of the side effects of treatment and making sure that we don’t under or over-treat patients. I think the types of testing that we have now such as genomic testing of tumors to help make decisions about chemotherapy and trials based on tumor biology are only going to expand to even more options to help women get the best, targeted therapy for them.
How do you support your patients before and after their surgeries?
I’ve found that women do the best after surgery when they feel most informed about what to expect during surgery and afterward, so they can get as prepared as possible. This includes having a complete discussion about the different surgical options and what to expect from each one, including possible complications; reviewing expectations and the timeline around anticipated return to daily activities, work, exercise, etc. after surgery; and making sure women have everything they need for after surgery before their surgery, from medications to garments to family support.
What do you feel are key aspects to living well after breast cancer?
From research studies and general information about cancer, probably the best things you can do for yourself after breast cancer are 1) exercise (ideally 30 minutes of moderate exercise 5 times per week), 2) maintain a healthy weight, 3) keep alcohol in moderation (4-5 drinks per week or fewer), 4) limit “inflammatory” foods such as processed foods or refined sugars, 5) keep in regular touch with your support networks, and 6) try to reduce stress (which is probably the hardest one!). It can be really difficult to make major life changes in the midst of the emotional and physical stress of breast cancer treatment, so I always suggest starting small and finding what realistically fits in your life.
Now a survivor, what do you do to maintain the future of your health?
Exercise has always been a huge part of my life, but I now really think about it as part of my treatment plan – research strongly supports exercise helping to reduce the chance of cancer coming back and making the management of side effects easier, so I use that for encouragement to get out of bed in the morning to work out!
How has having had cancer changed you and/or your family?
Although I don’t always succeed at this, I really try to be much more patient and forgiving with myself and my family. I have so many ideas swirling in my head about how to use my experience to dramatically change breast cancer care mixed in with thoughts about how I’m possibly going to balance all my aspirations with being an amazing mom to my three kids – I really work at just letting being healthy, strong, and present be enough most days, and helping my kids so they can feel the same.
