Breast Reconstruction in San Francisco & Sonoma County
At B.A.E., we believe the beauty of breast reconstruction lies in the incredible breadth of reconstructive options available. We will counsel you on all options, discuss your goals, priorities, and preferences, and help you select the best option for you! We work closely with your breast surgeon and oncology team to cater your treatment to your preferences, your specific cancer characteristics, and your body.
The range of reconstructive options we offer will be based on the mastectomy / lumpectomy incision, nipple preservation, surgical timing, and patient preference for implant-based or autologous reconstruction (using your own tissue). In most circumstances, insurance companies will cover the costs of your reconstruction, including procedures performed on the non-affected breast to help you achieve esthetic, matching breasts. We will help obtain insurance approval.
An ideal esthetic outcome provides women with reconstructed breasts that are symmetric, smooth, contoured, and perky. The ideal esthetic breast has a well-positioned reconstructed or preserved nipple-areola complex. Most importantly, an ideal esthetic outcome allows you to recover from your cancer journey by making you feel whole again in and out of clothes
Why Choose Bay Area Esthetics Plastic Surgery
- We provide an individualized and personalized approach to breast reconstruction, specific to your goals, your cancer, and your body.
- Our philosophy is to provide concierge plastic surgery care to counsel you thoroughly about all breast reconstructive options, answer all of your questions, be available if additional needs arise, and help you feel comfortable throughout the surgical journey.
- We offer the full spectrum of breast reconstruction techniques, including autologous / free flap breast reconstruction.
- We offer the latest techniques in breast reconstruction including prepectoral breast reconstruction, direct to implant reconstruction, and innervated autologous reconstruction.
- We offer immediate lymphatic reconstruction (ILR), also known as Lymphatic Microsurgical Preventative Healing Approach (LYMPHA) to decrease the risk of developing lymphedema after axillary lymph node dissection (for patients with cancer involving the lymph nodes).
Timing of Your Breast Reconstruction
Breast reconstruction is commonly performed in one or two stages. Some women desire additional surgeries for revisions, touch-ups, nipple reconstruction, and fat grafting to perfect their results. The first surgery can be performed at the time of your cancer operation or in a delayed fashion. Immediate breast reconstruction involves placing a tissue expander, breast implant, or autologous tissue flap immediately after the mastectomy to create a breast mound. Many factors, including your specific treatment plan and radiation therapy, may affect the timing of your initial or subsequent breast reconstruction procedures. If you have questions about the ideal timing for a procedure, please request a consultation or call / text 415-523-5235 to contact us.
Who Can Benefit from Breast Reconstruction
- Any patient undergoing a lumpectomy or partial mastectomy (removal of part of your breast)
- Any patient undergoing a mastectomy (removal of the entire breast)
- Any patient undergoing a complete axillary node dissection (removal or your lymph nodes)
- Any patient who has undergone a mastectomy or lumpectomy and did not receive prior reconstruction
- Any patient who has undergone previous reconstruction and seeks additional refinement
Your Breast Reconstruction Consultation Appointment
Before your first visit, you will be asked to complete an intake form to document your personal and medical history, prior surgeries, medications, and allergies.
At your visit we will review your goals and concerns. We will also review your specific breast cancer characteristics and cancer treatment plan. We will examine and measure your breasts and upper body from various angles to ensure we take into account the surrounding areas to maximize your breast appearance after reconstruction. We will also take photographs from various angles that will be used to help plan your surgery and track your progress after. We encourage you to write down your questions ahead of time so we can be sure to thoroughly answer any questions that you may have. We welcome you to bring a guest to the consultation to help you process and retain the information presented.
Meet Dr. Pourtaheri
An engineer before becoming a plastic surgeon, Dr. Navid Pourtaheri has a leg up when it comes to problem solving and surgical planning with the latest technology.
Breast Reconstruction Procedures
At B.A.E we are thoughtful about breast reconstruction and ensure we are satisfied with your results before leaving the operating room. We sit you up several times during surgery to make sure you look as perky and symmetrical as possible while upright and lying down. We offer a full spectrum of cutting edge and advanced breast reconstruction techniques to help achieve your goals.
- Oncoplastic Breast Reconstruction – Oncoplastic breast reconstruction can be offered to patients who are undergoing a lumpectomy (partial mastectomy) to fill in the area where breast tissue is removed and prevent a contour irregularity from forming in the breast. This can be performed with local flaps or with a breast lift (mastopexy) or with a breast reduction (reduction mammoplasty). Flap options using nearby tissue include the lateral intercostal artery perforator “LICAP” flap, the lateral thoracic artery perforator “LTAP” flap, and the thoracodorsal artery perforator “TDAP” flap. Mastopexy or breast reduction can be performed at the time of lumpectomy to lift or reduce the breast while filling the resection defect. A breast lift or reduction can also be performed on the opposite breast at the same time to achieve symmetry. Insurance should cover the procedures for both breasts.
- Implant-Based Reconstruction – Implant-based breast reconstruction is most commonly performed in two stages. A tissue expander is placed and gradually filled in clinic. At a second stage the tissue expander is replaced with a permanent breast implant. The tissue expander and implant can be placed under the pectoralis muscle (“subpec reconstruction”) or on top of the pectoralis muscle (“prepec reconstruction”). There are advantages to both options, which we will discuss at your consultation, and select based on your priorities and preferences. The breast implants used will be based on your personal preference – we offer a wide array of implant options that we can discuss at your visit.
- Direct-to-implant reconstruction – This is a form of implant-based reconstruction that involves placing a permanent breast implant at the time of mastectomy in a single stage. The ideal candidate for this technique is a woman who seeks breast reconstruction of a similar size to her current breast size. The possibility of this option will also depends on careful examination in the operating room, of the tissues remaining after mastectomy. Immediate placement of an implant can be stressful on skin healing, so if we have concerns we may opt for a two-stage option. In an ideal candidate, direct-to-implant reconstruction can decrease the number of surgeries and office visits to achieve your ideal results.
- Autologous Breast Reconstruction (DIEP Flap and PAP Flap Breast Reconstruction) – Autologous reconstruction (using your own tissue) is ideal for patients who do not want breast implants. Tissue is transferred from one area of your body to your breasts, most commonly from your abdomen (Deep inferior epigastric perforator flap or “DIEP Flap”) or from your inner thighs (Profunda femoral artery perforator flap of “PAP Flap”). At Bay Area Esthetics, we offer DIEP Flap reconstruction, as a muscle sparing procedure to save your rectus abdominis muscles and preserve abdominal strength and function. The tissue is transferred to the chest to create breasts and is supplied by arteries and veins that we connect under a microscope. After surgery your abdomen will be flatter and tighter, similar to patients who undergo a tummy tuck. In certain circumstances, the DIEP flap can also be connected to nerves in the chest, to provide sensation for your reconstructed breasts.
- Fat Grafting – Fat grafting is a technique that adds tissue to your reconstructed breasts to increase the size of your reconstructed breast and smoothen your breast contour. This technique is especially helpful to provide an extra layer of tissue over the implant and disguise visible implant edges or rippling. Fat grafting involves the removal of fat from other areas of your body, cleaning and preparing the fat, and transferring it to your breasts using syringes and small cannulas. Serial fat grafting with multiple sessions can greatly enhance your final results.
- Revision of prior breast reconstruction – At B.A.E. we offer revision breast surgery. If you have had prior breast reconstruction and seek correction of an animation deformity (abnormal breast appearance with muscle activation), we can move your implants to a pre-pectoral plane and perform fat grafting. We also offer capsulectomy (removal of the breast capsule) and implant exchange to treat patients with capsule contracture. We provide nipple-areola complex reconstruction for patients who would like a new nipple or are unhappy with the one they have. We also offer fat grafting to correct contour irregularities / visible implant rippling. For patients who no longer wish to have implants and would like to use their own tissue, we offer secondary autologous breast reconstruction.
- Immediate Lymphatic Reconstruction (“ILR”) or Lymphatic Microsurgical Preventive Healing Approach (“LYMPHA”) – An axillary node dissection removes lymph nodes from the armpit and can lead to lymphedema, a progressive swelling of the arm caused by the collection of lymph fluid in the extremity. Immediate lymphatic reconstruction (ILR) decreases the chance of developing lymphedema after an axillary node dissection. The procedure involves an axillary lymphovenous bypass, which is performed by connecting a lymphatic channel to a small vein to allow lymph fluid to drain from the arm. This bypass procedure is performed under a microscope with microsurgery technique and instruments. After your ILR, your arm elevation will be restricted for 2 weeks to allow for recovery.
Breast Reconstruction Recovery
We can perform your procedure in San Francisco or Sonoma County based on your preference. After the operating room, you will be taken to the recovery area to be cared for. Depending on the breast procedure you underwent, you may go home the same day or recover in the hospital for a few days. You will have surgical garments and dressings. Drains are typically needed in the first stage of reconstruction to reduce the chance of developing fluid collections and excessive swelling. They will be removed once the fluid output has decreased.
We follow a customized enhanced recovery after surgery (ERAS) protocol to best control your surgical pain, speed up your recovery, and limit the narcotic pain medications that you need. After surgery, you will have bruising and soreness for several days. Regular walking is encouraged to prevent blood clots, starting the morning after surgery. Arm range of motion exercises are encouraged to prevent shoulder stiffness and will be provided at your pre-surgery appointment. You will receive care instructions before and after your surgery and have plenty of time to ask questions. Please contact us online or call / text 415-523-5235 to discuss having your breast reconstruction with us at Bay Area Esthetics Plastic Surgery.
Contact B.A.E for more information or to schedule a consultation.
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