Pignato became First Lady of El Salvador on 1 June 2009, the same day that her husband, President Mauricio Funes, appointed her as the country's Secretary of Social Inclusion from 2009 to 2014.

Pignato's Ciudad Mujer initiative has received international support and recognition, including from the Inter-American Development Bank and the United Nations.

In January 2015, the Brazilian government announced plans to launch its own "Women's House" project, modeled on Pignato's Ciudad Mujer program in El Salvador.

She began documenting human rights abuses in El Salvador during the Salvadoran Civil War, which was ended by the Chapultepec Peace Accords.

[5] She overcame opposition against the plan from several sectors of Salvadoran society, which included politicians, evangelical Christian groups, and the Roman Catholic Church, to launch Ciudad Mujer.

[1] In October 2011, ten days of heavy rain led to severe flooding which affected 70% of El Salvador and damaged approximately 80% of the country's roads.

[2] Then President Mauricio Funes estimated that damages totaled $840 million, equal to 4% of El Salvador's gross domestic product (GDP).

[2] She also met with United Nations Secretary General Ban Ki-moon, former U.S. President Bill Clinton, the Salvadoran American community and representatives for the corporate sector.

[2] The National Ethnic Coalition of Organizations (NECO) awarded Pignato the Ellis Island Medal of Honor in May 2012, citing her cooperation with the Salvadoran American community and her initiatives to support women's rights.

[citation needed] Jorge Cortez, head of the Financial Unit of the Attorney General of the Republic (FGR), explained that they had requested that Pignato only pay a bond to be processed in freedom as a consideration for her health condition.