Breast Reconstruction in the San Francisco Bay Area
Restoring More Than a Silhouette
A mastectomy or lumpectomy treats the cancer. It also leaves a daily, visible reminder of it. For many patients, reconstruction is the step that lets ordinary routines, getting dressed, catching a reflection, moving through the day, stop referring back to the diagnosis.
Breast reconstruction restores the shape of the breast after cancer surgery, whether performed at the same time as the mastectomy or months to years later. At NorCal Plastic Surgery, board-certified plastic surgeon Dr. Timothy Rankin plans reconstruction in coordination with each patient's oncology team, around her anatomy, treatment plan, and priorities.
Consultations are available in Tiburon for patients throughout Marin County and the greater San Francisco Bay Area.
What Is Breast Reconstruction?
Breast reconstruction is a surgical procedure, often a planned sequence of procedures, that rebuilds the shape of one or both breasts after mastectomy or lumpectomy. Reconstruction is frequently begun during the same operation as the cancer surgery, called immediate reconstruction, but delayed reconstruction remains possible long after treatment has ended.
There are two fundamental approaches: reconstruction with breast implants, and autologous reconstruction, which rebuilds the breast from the patient's own tissue. Each has genuine advantages, and the right choice depends on the body, the cancer treatment plan, including any radiation, and the patient's goals.
Implant-Based Reconstruction
Implant-based reconstruction is generally performed in stages. In the first stage, a tissue expander is placed to preserve and gradually stretch the breast skin. In a later operation, the expander is exchanged for the final implant, and fat grafting may be added to soften contours and improve the transition between the implant and the chest.
The implant or expander may be positioned prepectorally, on top of the chest muscle, or submuscularly, behind it. Dr. Rankin generally prefers prepectoral placement when the tissue allows, because leaving the muscle undisturbed tends to mean less postoperative pain and an easier recovery.
An optional final stage addresses the nipple, through nipple reconstruction, three-dimensional medical tattooing, or both.
Autologous (Flap) Reconstruction
Autologous reconstruction rebuilds the breast from the patient's own skin and fat, transferred with microsurgical techniques. The most common donor site is the lower abdomen, using the DIEP flap, which spares the abdominal muscle. The buttocks and inner thigh are alternative donor sites when the abdomen is not suitable.
A breast rebuilt from living tissue feels natural, ages with the body, and does not require implant maintenance over a lifetime. The trade is a longer, more complex operation with an additional donor-site incision and recovery.
Who Is a Candidate for Breast Reconstruction?
Most patients facing or recovering from mastectomy or lumpectomy are candidates for some form of reconstruction. Implant-based reconstruction requires enough healthy skin and soft tissue to cover the implant, while autologous reconstruction requires an adequate donor site.
Candidacy and timing are determined together with the oncology team, including the surgical oncologist, because chemotherapy, radiation, and the specifics of the cancer surgery all shape what reconstruction is possible and when. Radiation in particular influences the choice between implants and the patient's own tissue.
Smoking, medical conditions, and prior surgeries are also part of the evaluation. Patients who chose not to reconstruct at the time of mastectomy can revisit the decision later; delayed reconstruction is common and effective.
How Is Breast Reconstruction Performed?
Dr. Rankin performs breast reconstruction under general anesthesia at accredited surgical facilities with board-certified anesthesiologists, coordinating the surgical plan with the patient's oncology team.
Immediate reconstruction begins in the same operation as the mastectomy, typically with expander or implant placement. Delayed reconstruction is scheduled once cancer treatment allows. Staged procedures are spaced to let the tissue heal, generally with a minimum of about three months between stages, and revisions such as fat grafting or adjustments to the opposite breast for symmetry, including a lift, reduction, or augmentation, may be incorporated along the way.
What Is Recovery Like?
Recovery depends on the approach. After implant-based stages, most patients need help at home for the first week or two and avoid strenuous activity for about eight weeks, with lighter routines resuming sooner. Autologous reconstruction involves a longer initial recovery, up to about eight weeks, because both the chest and the donor site are healing.
Drains, dressings, and activity restrictions are reviewed in detail before each stage. Reconstruction is a sequence rather than a single event, and the schedule flexes around ongoing cancer treatment when needed.
Most reconstructed breasts have reduced or absent sensation, and scars are permanent, though they fade. Knowing this in advance matters: reconstruction restores shape and silhouette, and for most patients that restoration is profoundly worthwhile, but it does not recreate the breast exactly as it was.
What Are the Risks?
Possible risks include bleeding, infection, fluid accumulation, delayed wound healing, skin or flap loss, implant-related complications such as capsular contracture or rupture, asymmetry, changes in sensation, donor-site complications, anesthesia risks, and the need for revision surgery. Radiation therapy increases certain risks and is weighed carefully in planning.
Dr. Rankin reviews the risks specific to each approach, stage, and treatment history before consent. Reconstruction does not generally interfere with detecting a cancer recurrence, and ongoing surveillance continues with the oncology team.
Why Choose Dr. Timothy Rankin for Breast Reconstruction?
Reconstruction asks more of a surgeon than most cosmetic breast surgery: it must rebuild shape from altered anatomy, coordinate with oncologists on timing, and hold up through radiation, healing, and years of living.
Dr. Rankin is certified by the American Board of Plastic Surgery and is a Fellow of the American College of Surgeons. He completed a full general surgery residency at the University of Arizona, where he served as chief resident, followed by plastic surgery training at Vanderbilt University, with training encompassing breast surgery and microsurgical reconstruction.
His role is to lay out the honest trade-offs between implants and your own tissue, immediate and delayed timing, and staged refinements, and then build the plan around your treatment and your life. Patients exploring related options can also review the full range of breast procedures offered at the practice.
Frequently Asked Questions About Breast Reconstruction
Does insurance cover breast reconstruction?
In most cases, yes. Under the federal Women's Health and Cancer Rights Act, group health plans that cover mastectomy are generally required to cover breast reconstruction, including procedures on the opposite breast for symmetry. Our team can help you understand your specific coverage, and financing resources are available for costs that remain.
Should I have reconstruction at the same time as my mastectomy?
Immediate reconstruction, begun during the mastectomy operation, preserves breast skin and spares a separate recovery, and it is the most common path. Delayed reconstruction is the better choice for some patients, depending on radiation plans, healing, and personal readiness. The decision is made together with your oncology team, and choosing to wait does not close the door.
Should I choose implants or my own tissue?
Implant-based reconstruction involves shorter operations and no donor site, but implants may need maintenance or replacement over a lifetime. Autologous reconstruction, such as a DIEP flap from the abdomen, creates a breast of living tissue that feels natural and ages with you, at the cost of a longer surgery and donor-site recovery. Anatomy, radiation history, and priorities drive the recommendation.
What does prepectoral placement mean?
It means the implant or tissue expander sits on top of the chest muscle rather than behind it. Dr. Rankin generally prefers prepectoral placement when the tissue quality allows because leaving the muscle undisturbed typically means less pain, an easier recovery, and no distortion of the breast when the muscle flexes.
How many surgeries will I need?
Often two or three stages: initial expander or implant placement, an exchange or refinement stage at least about three months later, and an optional stage for nipple reconstruction or tattooing. Autologous reconstruction may be completed in fewer stages. Revisions for symmetry or contour can be incorporated along the way.
Will my reconstructed breast have a nipple?
It can. When the nipple cannot be preserved during mastectomy, it can be rebuilt later through nipple reconstruction, three-dimensional medical tattooing, or both. Some patients choose tattooing alone for its realistic appearance without additional surgery, and others choose to forgo this stage entirely.
Will my reconstructed breast feel normal?
Reconstruction restores shape, but sensation is usually reduced or absent because the nerves are divided during mastectomy. Breasts rebuilt from your own tissue tend to feel more natural to the touch than implants. Setting this expectation honestly beforehand is part of good reconstructive care.
Can I have reconstruction years after my mastectomy?
Yes. Delayed reconstruction is common and effective, whether the original surgery was last year or a decade ago. The available approaches depend on your tissue and treatment history, particularly radiation, which an examination and consultation can sort out.
Request a Breast Reconstruction Consultation
Whether you are planning reconstruction alongside a scheduled mastectomy or revisiting the decision years later, a consultation can lay out the approaches your anatomy and treatment history support. Dr. Rankin will coordinate with your oncology team and build a plan around your health, your timeline, and your goals.
Request a consultation at the Marin County office in Tiburon by calling (415) 727-9666. You may also schedule a consultation online.
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