March 3, 2022

Deconstructing Kristen’s Breast Reconstruction with Plastic Surgeon Dr. Salvatore Pacella (Part 1)

Deconstructing Kristen’s Breast Reconstruction with Plastic Surgeon Dr. Salvatore Pacella (Part 1)

Kristen’s plastic surgeon Dr. Salvatore Pacella joins us to deconstruct her breast reconstruction and help us understand his strategy for the multi-stage approach in which the expanders are placed at the time of mastectomy and replaced with breast implants following radiation.

Kristen’s plastic surgeon Dr. Salvatore Pacella joins us to deconstruct her breast reconstruction and help us understand his strategy for the multi-stage approach in which the expanders are placed at the time of mastectomy and replaced with breast implants following radiation.

We ask all the unanswered burning questions, including whether he can even recognize Kristen with her clothes on and how the recent consumer trend of moving fat to increase the size of one’s rear end has had a positive impact on reconstructive surgery.

From the decisions made at the beginning of the process, to the ignorant things people say to women about to undergo breast reconstruction, we covered it all in this first episode of a two-part series.

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Listen to Dr. Pacella’s podcast, Three Plastic Surgeons and a Microphone:

Meet Kristen’s doctors: surgical oncologist Dr. Louis Rivera, hematologist and oncologist Dr. Sonia Ali, plastic surgeon Dr. Salvatore Pacella, and radiation oncologists Dr. Anuradha Koka and Dr. Kenneth T. Shimizu.

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About Breast Cancer Stories

Breast Cancer Stories follows Kristen Vengler, a 56 year old single empty nester in San Diego, from her diagnosis of hormone positive breast cancer through chemotherapy, mastectomy & breast reconstruction, radiation, and whatever happens after that.

In 2020, Kristen moved from Austin to San Diego to be near family and start her life over after a life-shattering workplace trauma. A few months later she had that terrifying moment in the shower we all hope we never have.

From her breast cancer diagnosis, through chemotherapy, breast reconstruction, and radiation, we experience each new milestone as it happens. This podcast is about what happens when you have breast cancer, told in real time.

Support the show by sharing online, writing a review, or donating at

Host and Executive Producer: Eva Sheie
Co-Host: Kristen Vengler
Editor and Audio Engineer: Daniel Croeser
Theme Music: Them Highs and Lows, Bird of Figment
Production Assistant: Mary Ellen Clarkson
Cover Art Designer: Shawn Hiatt

Breast Cancer Stories is a production of The Axis.


Special Guest: Salvatore J. Pacella, MD.


Eva Sheie (00:08): This is a story about what happens when you have breast cancer, told in real time. Today, on the podcast, on Breast Cancer Stories, we've got Kristen's plastic surgeon, Dr. Pacella with us from San Diego. And he's been responsible for Kristen's reconstruction for quite some time now. And I want you to introduce yourself Dr. Pacella, but I want you to save the long version for the end and we'll come back to it. For this moment, will you just tell us how you've been doing breast reconstruction and maybe guess how many you've done so that we have a feel for how much of your practice is dedicated to that?

Dr. Pacella (00:50): Sure. Well, thank you both for inviting me on the podcast. It's really special and I'm super excited to chat here in this venue. It's really fantastic to see Kristen out and about and living life. And hopefully we can get on to a point of normality at some point

Kristen Vengler (01:06): I was joking with Eva. I was like, "I think this is the first time he's seen me with clothes on."

Dr. Pacella (01:11): I think so. Yeah, that's right. You usually undress by the time you come in. It's funny. Well, to answer your question, so I've been in practice about 13 years and breast reconstruction is a bread and butter type of operation for plastic surgeons who train at any center for that matter. So it's a fairly common procedure that we perform. Breast cancer, as you know, is an exceptionally common disease and cancer that women experience, one in eight throughout your lifetime. So as far as the extent of breast reconstruction I do in my practice, I probably do about 40% cosmetic surgery and about 60% general reconstructive surgery. Of the 60% reconstructive surgery, I do probably about half of that is patients like yourself doing breast cancer reconstruction.

Dr. Pacella (02:02): I trained as not only a plastic surgeon who does reconstructive surgery, so for trauma and cancer and disease, but I also did a specialized fellowship in cosmetic surgery of the breast. And that is relatively unique in the sense that most surgeons who do a dedicated cosmetic surgery fellowship eventually really go into private practice and subsequently just really do breast cosmetic surgery. But I sort of went the other way around. I did a cosmetic fellowship and then came back and did reconstructive breast surgery. And to me, I think that brings a lot to the table from the standpoint of when I'm thinking about how to reconstruct a breast. It's not just simply creating a breast mound there. Quite honestly, my strategy is to make most patients or make all patients look better than they did before they had a mastectomy. And I know that sounds a little odd to say, but there's a lot we can do to really create fullness to the breast, to create volume, to create a situation where patients are happier after their breast reconstruction, than before their mastectomy, even.

Eva Sheie (03:11): I think that's really interesting. What comes to my mind is a burning question, in fact. Well, to the very beginning for the patient. So somebody is diagnosed, they get kind of whisked into this really intense labyrinth of stuff and they probably, I'm guessing, and I know this is probably true. Kristen's an extraordinary researcher so she turned over all the rocks, but most people don't, you sort of kind of throw up your hands and say, "Now what happens to me?" And how much control do you have from the beginning of that diagnosis over how you get referred, who you get referred to, who those surgeons are? Is that something that is in the control of the patient?

Dr. Pacella (03:56): That's an absolutely excellent question. And I think it really has to do with the dynamics of how we deliver healthcare in this country. And unfortunately, it's sort of all over the board. For example, where we do it, at Scripps MD Anderson, we have a dedicated breast cancer team. When you are diagnosed with breast cancer, let's say you feel something, your primary care physician gets you a mammogram, a biopsy is performed. Then basically, a tag goes off in your medical record and you're set down this pathway. Well, you need to see an oncologist, you need to see a general surgeon, you need to see a plastic surgeon, you need to see a radiation oncologist. And so it's sort of a checklist that goes down and the patients are funneled into this program, called the multidisciplinary clinic. And so when you're diagnosed within a center like that, you can be certain that every box is checked. So although it's exceptionally overwhelming, there's a navigator that's going to make sure that you're going to all these appointments and that you're getting everything you need out of this particular process.

Eva Sheie (05:04): There's a person.

Dr. Pacella (05:05): Correct, yeah. It's actually a dedicated nurse that her entire job is to create a process for patients to come through the system. So it's really nicely done because you can, with good faith, just give the process over to somebody else because obviously, as a patient, Kristen, I'm sure you'll agree, you're thinking about a lot, "Oh my God, I have this appointment. Do I need to see this person?" So the beauty of being part of a breast care center like this is that all of that's taken care of you. You just show up at this time, this time, this time, this time. And in fact, with the multidisciplinary clinic, many times, all those appointments are done in the same day.

Dr. Pacella (05:46): Now the consequences, that can be exceptionally overwhelming for you. So it gives you a chance to collect all the information and then go through it at a later date. Now, let me put that on hold for a second here, I want to come back to that. Now, unfortunately, at other various parts of the country, particularly if you're not affiliated with a larger medical group or a larger center, or if a lot of PPO patients, unfortunately, are in a situation where they say, their primary care doctor says, "Go see this breast surgeon." And perhaps, that surgeon may not be affiliated with a distinct hospital cancer center. So that gets a little bit overwhelming because you're really at the mercy of the first person that you see. So for example, that person may not get you locked into an oncologist immediately, or that general surgeon that sees you may not say, "Hey, well, I'm not going to send her to the breast reconstructive surgeon just yet, because I don't think it's important. We need to clear the cancer out and they can worry about the reconstruction later."

Dr. Pacella (06:49): On the converse, many patients are taking a very unique way of coordinating their care. Kristen, you mentioned you're a great researcher, right? So I almost see that to the bell curve. So for example, you get diagnosed with breast cancer, there'll be a patient that says, "Well, I'm going to go see the best breast surgeon that has the best reviews." So they go to see that person. And then they say, "Well, I'm going to go see the plastic surgeon that has the best reviews." And okay, so I've chosen the best plastic surgeon, I've chosen the best general surgeon, and then I'm going to have them work together. Well, sometimes that may not lock in. That general surgeon may not really do cases with that plastic surgeon. They may not have a process. So you may have the best of the best, but the way those two integrate, that's not a common connection with their Legos, so to speak. Same thing goes with the radiation oncologist or the general oncologist. So having a team behind you, I think is a critically important thing to get through this process in a smooth way.

Eva Sheie (07:54): I would think also the speed is important too, because-

Dr. Pacella (07:56): Yes.

Eva Sheie (07:57): You have cancer and you have a tumor that's growing. You don't want weeks between your appointments.

Dr. Pacella (08:03): Right.

Kristen Vengler (08:03): Absolutely. Well, I did feel like I was a little bit in, I guess, Times Square in New York.

Dr. Pacella (08:11): Correct, right.

Kristen Vengler (08:11): Watching all the traffic go by, when all of this was happening. And my insurance actually is HMO, and it was such a relief to have all of that stuff, just automatically the referrals just went. And so luckily the radiologist sent me to Dr. Rivera and then he sent out all the referrals, like you're talking about. And then of course, it was right before Christmas, but by January 11th, I was getting my first chemo dose. And that week before was probably one of the most stressful of my life, because I was going for scans. I added a colonoscopy just for fun because I figured I was getting one anyway. So if we're looking for things, we may as well take a look. And it was fast and furious, but I didn't have to wait weeks for results.

Kristen Vengler (08:58): It was explained to me by the nurse navigator that Dr. Koka and Dr. Rivera and Dr. Ali, they all met on a weekly or biweekly basis. And knowing that you and Dr. Rivera had performed numerous surgeries before gave me so much, just peace. We haven't talked about this, but you were very complimentary of him and he was very complimentary of you, separately in different appointments. That gave me a lot of confidence also. But you're right, I can't imagine having to go and choose the best this and the best this, and piece together all of that while you're crying every other hour.

Dr. Pacella (09:37): Right. Right.

Kristen Vengler (09:38): And someone else is saying, "How did this happen?" And you're explaining it to family members and there's the emotional pieces. I don't think you know this Dr. Pacella, when it was time for me to come to get my referral to come see a plastic surgeon from my reconstruction, I went through all of the Scripps' plastic surgeons and then I went out through all of the ones that did reconstruction, breast reconstruction. And then I went to every webpage and I read everything and I looked at all the breasts.

Eva Sheie (10:06): She did.

Kristen Vengler (10:06): I did, I'm a nerd. And I had my top three, and you're number one. And I was like, "I hope I get Dr. Pacella." And I didn't know how the referral process went. So when I called and they said, "Okay, we're going to set you up with Dr. Pacella," I was actually driving. And I was like, "Yes."

Eva Sheie (10:23): That's great.

Kristen Vengler (10:24): Yeah. But you wouldn't know that from behind the scenes. And when I do research, I'm never going to go in and question what someone's doing, I just want to understand why.

Dr. Pacella (10:32): Right, right.

Eva Sheie (10:33): I was back channeling all my San Diego connections to find out if you're legit too.

Dr. Pacella (10:39): Great.

Eva Sheie (10:39): Everybody said, "He's fine. Don't worry."

Dr. Pacella (10:42): That's good to hear. All right.

Dr. Pacella (10:45): And so I just want to circle back to what you said about the members of the team. To me, as a plastic surgeon working within the context of this big cancer center, one of the best things of my job is my colleagues. So oftentimes, when you're a plastic surgeon in private practice, you're sort of in your own silo, you don't really interact with anybody really. And I very much interact with a lot of my subspecialty colleagues like Dr. Rivera, Dr. Ali, Dr. Koka, and they're just exceptional physicians. And Lou, specifically, he's not only a great surgeon, he's an exceptional surgeon and he's a fantastic guy, too. He's somebody that I can call at any time of day and say, "Hey, I have this patient, I have this issue. What do you think? Can I get your idea on this?" And he does his stuff staying in his lane, I do my stuff staying in my lane. But the best thing is, as we're driving along the highway, we're able to talk to each other and work towards a process, and it's very streamlined that way.

Dr. Pacella (11:51): And you'll notice that in being part of the multidisciplinary clinic with Scripps MD Anderson, Kristen, when you were seeing those doctors, my appointment was not within that multidisciplinary group. And that's for a very specific reason. As a plastic surgeon, I don't want to downplay what we do, but we are the most non-integral part of that process, right? We are the ones that see you last because obviously, the primary importance is getting you cured of your cancer. And quite honestly, sounds a little rough, but you don't need a breast to live. We never want to lose sight of that. And so my philosophy is I want to see you a few days after you've had a chance to digest all of that so that we can talk about the reconstruction.

Dr. Pacella (12:39): And then if the reconstruction is right for you, we go ahead. If it's not, and you say, "Hey, well, this is not the right time," we can always do a reconstruction later or not do one at all, depending on what's best for each particular patient. And so having that little bit of time to digest, I think is really critically important. Whatever it is that the oncology group throws at us together, we're going to be able to manage that, whether or not it's radiation or more chemo, or we have some wound healing problems, we always have to defer to the oncologist. That's the key point here?

Kristen Vengler (13:17): I remember I came in, post-surgery we're doing a fill and no one had really said, "You have to have radiation." Dr. Rivera had said, "I strongly suggest it, I don't know why you wouldn't," going as radical I was with double mastectomy and with the skin involvement. And I said to you, "How do I know? What questions do I ask?" And you were saying, "Get the numbers." And what you said was, "Dr. Ali's your quarterback on this." She's calling the plays. And there was so much respect that all of you had for one another and for staying in your lane. It was good to hear. And I feel like I can ask just about anything. I feel like the group really allows for a lot of information gathering and making sure that the patient feels comfortable with where we're going with it.

Dr. Pacella (14:06): That's great to hear. That's really nice to hear.

Kristen Vengler (14:08): Yeah. It's interesting. I had friends saying, "Well, this isn't that much different than having a boob job. Why are you stressing about it?" I'm like, "Well, aside from the whole cancer, it is different." And then the other thing they say is, "At least you're going to have great boobs after this."

Eva Sheie (14:24): We're working on an episode called, Things You Shouldn't Say to People With Breast Cancer.

Dr. Pacella (14:29): That's a great topic. Great topic.

Kristen Vengler (14:32): So can you give a little bit of your background on how these two things differ?

Dr. Pacella (14:37): I'm glad you brought that point up because that's something I oftentimes are having discussions with patients and family members about. And you are absolutely correct that many people come into this process thinking, "Oh, it's just a breast augmentation and it's going to be easy. It's a one and done operation." They are two worlds apart. And when I mean two worlds apart, I mean, Earth and Mars. They couldn't be any different. This is a very crude analogy. So imagine you have some water damage in your house, it's kind of creeping up through the sides of the wall, et cetera. There's a difference between, say patching everything as opposed to demoing the entire house and rebuilding it from scratch. And that's essentially what we're doing with a mastectomy. We have to essentially rebuild every single aspect of the breast from the breast, from the fold of the breast to the skin, to the volume underneath. It is an exceptionally taxing process for patients.

Dr. Pacella (15:40): And I think one of the things you and I talked about when we first met was getting wrapped around the fact of, this is a multi-step process, it is not easy. It is going to be painful at times, it's going to be uncomfortable at times. Whereas, breast augmentation, it's kind of a one and done operation. You have small breasts, you put in an implant. Couple weeks of recovery, everybody's happy. It's not that challenging compared to, I think, a breast reconstruction. The expanders are very uncomfortable. They feel rock hard. They feel like basketballs. If they weren't firm, they wouldn't do a very good job of expanding, particularly during the radiation process. The fact that you've had radiation is a huge challenge for you as well. And getting things to line up appropriately are key concepts here for us as we go through the process. So the two worlds couldn't be farther apart.

Kristen Vengler (16:34): It's really interesting that you said demo. Wait, is that what you were thinking of?

Eva Sheie (16:40): Yeah, that's what you called it.

Kristen Vengler (16:41): She laughed at me because I said, and it really was my way of not saying I'm having a double mastectomy and crying every time. I said, "Well, Dr. Rivera is doing demo and Dr. Pacella's going to do the rebuild."

Eva Sheie (16:56): And I said, "Only someone who's addicted to HGTV would [crosstalk 00:16:59] that analogy."

Kristen Vengler (17:01): So it's perfect, we were on the same page. It's interesting because people don't really understand what the whole expander situation is and people think I'm weird, just like, "Oh, you got to feel this." And they're like, "That feels like a rock." And I'm like, "Well, yeah, it's supposed to be that way. It has to be that way for radiation." And it probably got tighter through radiation, right?

Dr. Pacella (17:20): Right. Yeah, absolutely.

Eva Sheie (17:22): So this is a perfect time for me to ask one of my other questions that is really important. Describe what's going on right now. Because you're sort of halfway through roughly, right?

Kristen Vengler (17:33): Right.

Eva Sheie (17:33): This is a multistage process. You're halfway through. Describe what they look like right now for the audience. And then Dr. Pacella, please help me understand the long game here because there's some Frankenbooby shit going on under here.

Dr. Pacella (17:47): Yep. Yep.

Eva Sheie (17:49): Technical term.

Kristen Vengler (17:50): Yeah. So the breast cancer is in the right breast, right? It was stage 3B. It was in the nipples. So no nipples, it was a skin saving procedure, not an areola saving procedure. So I have my right breast that has been radiated and I think it has about one or 200ccs saline in it.

Eva Sheie (18:10): More than the other.

Kristen Vengler (18:11): More than the other.

Dr. Pacella (18:12): Correct. Right. That's right.

Kristen Vengler (18:13): Yeah. It's up high, it's very round, it's very hard. And the left one is probably where the scar is, is probably about two inches lower and it's not as firm. And I strategically wear things you can't tell where the breasts are. I think the first time I saw Eva, I had on a shirt that had stripes across the top. She's like, "Oh, I see now." And so the left one is actually a little flatter and a little lower, but that's by design.

Dr. Pacella (18:47): Let me kind of start from the beginning, here. So I think we had a very good understanding that you most likely would need radiation after the mastectomy. So we know from experience that radiation, we have a saying, is predictably unpredictable. And it is permanent. We know when a breast gets radiated or when any tissue gets radiated, it retracts, it gets firmer and it rides up high. So going into the surgery, we want to account for that somehow, because if I make both breasts, going into radiation, identical, I know that once it hits radiation, it's going to be much less symmetric afterwards. So with Kristen here, and all of our patients who undergo radiation, we have a strategy, which is we want to overfill the radiated side substantially and we want to actually underfill the non-radiated side.

Dr. Pacella (19:47): The reason being is when the radiation beam comes in, it comes in at an angle. So if I have two real big, symmetric breasts like this, having the radiation hit the opposite breast at an angle is not a good thing. So we want to deflate the opposite side so that the angle of radiation can get as close to the treating breast as possible. That avoids any damage to the lungs or to the heart, et cetera. So it's coming in at an angle. So we don't want the normal breast to get in the way of that. So by nature, it's almost like this. If we're shooting for this, the normal side has to be lower, the radiated side has to be much bigger. So one of the things I counsel patients early on is, you're going to be really off kilter for close to a half a year.

Dr. Pacella (20:32): And if you recall going into radiation, you were a lot bigger on the one side, but the fold of the breast was probably much more symmetric. After radiation, everything kind of rid up high. So that over expansion is designed to accommodate for that. So when we go in and put in the final implant, we're actually going to use a little bit of a smaller implant than were radiated, so that the implant can be nice and soft in the pocket and drop down a little bit lower. And then on the opposite side, we're probably going to have to do some skin rearrangement, lifting things up to kind of make it look like the radiated side a little bit more.

Kristen Vengler (21:09): I remember you explained that to me, "This is why it's going to be this way." And there were no beams hitting it.

Eva Sheie (21:16): So then how does she get her nipples back, or are they not coming back?

Dr. Pacella (21:20): We'll have essentially two more surgeries to do. So we're really just one third of the way through. So the next surgery would be removing the expanders and putting in the permanent implant. How I envision that surgery is we're going to get as close to getting two symmetric breast mounds as we can in position. Now, invariably, what happens is after that second surgery, you have symmetric breasts, but there's some detail that needs to be done around it. So think about this like a block, you're doing a sculpture. You don't start by doing all of the detail at the beginning, right? The block of tissue here, like this, we got to make a form. Okay? And then the second surgery, we kind of make a little bit more detail to make it look more like an arm, the third surgery, we're sort of making all the little fine refinements to make it look as close to a breast as possible.

Dr. Pacella (22:13): So we're just one third of the way through that. So we've just really kind of chipped away at the block. The next stage is getting the mound of everything together. So invariably, what happens is that radiation will thin out all of the skin. Even in a non-radiated situation, what will happen is there's a point where the ends and the mastectomy kept going. And so with any reconstruction, there's going to be a little bit of a divot on the upper pole of the breast or along the cleavage. And so that's what can look very unnatural during a reconstruction.

Dr. Pacella (22:46): So a really awesome technique that we use for the third stage is something called fat transfer. So we'll go through your abdomen or wherever we can get some fat from, and we'll take some fat out, just like we would for liposuction for cosmetic reasons, and we'll set those fat cells, they have adipose derived stem cells in them, and we'll thin those down and we'll purify them and re-inject them back into the breast. And what that does is it creates a much nicer, more aesthetic contour to the upper pole and the cleavage area in order to fill things in a bit better. And so that fat transfer can really work wonders.

Dr. Pacella (23:25): And at that stage, we'll do a nipple reconstruction more formally. Now, the options for nipple reconstruction, if we're looking for something a little bit more three dimensional, there's a series of little flaps that we can do to rebuild you a nipple. Some women, at this stage, just simply opt for a tattoo to put the nipple back on. It's a little technical to really make a good nipple. And with the radiation side, sometimes that's a little bit of a challenge. So that's certainly a discussion for us before our last surgery.

Eva Sheie (23:55): When did fat transfer become the final stage of choice? I had written content about breast reconstruction for probably a decade and I don't remember that in the early 2000s or even the early teens being part of the process.

Dr. Pacella (24:11): That's correct. In fact, fat transfer has really grown exponentially, I think in the last 10 years. Probably actually even in the last five to eight years, more than anything else. The reason being is there has been a significant amount of science in plastic surgery surrounding fat transfer and transplanting fatty cells.

Dr. Pacella (24:31): Coupled with that, there has been a tremendous amount of innovation in some of the companies that we've been working with, creating filters and processes to really streamline fat. Years ago, when we used to do fat transfer for any reason, it was kind of a voluminous procedure, it took a lot of time. There wasn't a really good way to filter the fat very nicely. Some of my mentors in the past, I hear crazy things like they would buy strainers from Williams and Sonoma and sterilize them and use them in the operating room. It sounds ridiculous, but there was just nothing available to treat that fat. And now we have a handful of companies that really provide excellent products to really streamline the process, to make it a sterile, contained process. Then it makes it much easier for surgeons and patients to get the procedure.

Eva Sheie (25:22): Would you say that has been driven by a consumer trend?

Dr. Pacella (25:26): I think part of it is. I'll go back to the reflection of cosmetic surgery versus reconstructive surgery and how many times those are very complimentary. So for example, I do a lot of facial surgery. One of the things we're realizing, as we do more facial surgery, is that when we age in the face, it's not just that everything kind of drops down, it's that we lose volume in the face. We lose fatty tissue. And so if you look at somebody who's 99 years old, their face oftentimes looks very skeletonized. And if you look at a baby who's two years old, their face is very full and youthful. And the reason being is that fatty tissue. So consequently, we see a lot of patients that are very fit in their sixties and seventies that look much older because the fat that they've lost creates a gaunt appearance to the face. So there's been kind of a re-evolution of injecting fat into the face and making it look very natural. And by corollary, that has been getting very popular in breast surgery.

Eva Sheie (26:28): We'll be back for part two of this conversation with Kristen's plastic surgeon, Dr. Sal Pacella, on our next episode.

Eva Sheie (26:37): Thanks for listening to Breast Cancer Stories. There's a link in the show notes with all of the resources mentioned on this episode and more info about how you can donate. If you're facing a breast cancer diagnosis and you want to tell your story on the podcast, send an email to I'm Eva Sheie, your host and executive producer. Production support for the show comes from Mary Ellen Clarkson, and our engineer is Daniel Croeser. Breast Cancer Stories is a production of The Axis,

Salvatore J. Pacella, MDProfile Photo

Salvatore J. Pacella, MD

Plastic Surgeon / Author

Dr. Salvatore J. Pacella serves as Division Head of Plastic Surgery at the prestigious La Jolla-based Scripps Clinic.

He has authored over twenty peer-reviewed publications in plastic surgery and healthcare economics, as well as seven book chapters in cosmetic and eyelid surgery and he has been invited to present regularly at national and international plastic surgery meetings.

With clinical staff appointments at Scripps Green Hospital, Scripps Memorial Hospital La Jolla, Scripps Encinitas and Rady Children’s Hospital, he is often consulted by other surgeons to treat the most complex reconstructive problems.

Originally from Buffalo, New York, Dr. Salvatore Pacella graduated Summa Cum Laude from St. Bonaventure University with a B.S. in Biochemistry. He attended medical school at the University of Rochester where he graduated with high honors. While in residency in plastic surgery at The University of Michigan, Dr. Pacella was awarded numerous distinctions for clinical research and teaching.

He earned his M.B.A. at The Stephen M. Ross School of Business at The University of Michigan, widely recognized as one of the nation’s top business schools.

As an avid believer in extending care to the disadvantaged, Dr. Pacella volunteers regularly with San Diego-based Fresh Start Surgical Gifts, a non-profit organization providing donated surgical services to children with facial and bodily disfigurement. In 2010, he was awarded a San Diego Heath Hero Award for his philanthropy efforts.

Find out more about Dr. Pacella on his podcast with fellow plastic surgeons Dr. Sam Jejurikar and Dr. Sam Rhee at