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Breast reconstruction surgery is a restorative and empowering spectrum of procedures for breast cancer patients or women seeking prophylactic risk-reducing surgery. San Francisco Plastic Surgeon Dr. Karen Horton is a leader in breast reconstruction surgery, complex breast revision procedures, and a passionate advocate for breast cancer survivors.
Please note: Our office is no longer a Participating Provider for insurance. We can provide a financial quote for what anticipated surgical fees will be after your consultation.
Breast Reconstruction at a Glance
Breast reconstruction restores shape and symmetry after mastectomy or lumpectomy using implants or natural tissue. Techniques vary based on anatomy, treatment history, and goals. Options include immediate or delayed reconstruction, implant-based or autogenous/autologous tissue reconstruction, with personalized care to support healing, appearance, and emotional well-being.
Breast reconstruction is a surgical procedure performed after a mastectomy or lumpectomy for breast cancer. The goal is to restore a natural-looking breast shape and to maintain or create improved symmetry between the breasts, which may be achieved with breast implants, autologous tissue techniques, or a combination. Even after breast-conserving surgery like a lumpectomy, reconstruction may still be beneficial. Reconstruction can help women regain a sense of wholeness and confidence after breast cancer treatment.1
We know that a breast cancer diagnosis or being a carrier for the BRCA gene (or other cancer genes) is a frightening and life-changing challenge. We are honored to help women through this difficult time with reconstructive options to help preserve or restore their body image, a sense of femininity, and feeling complete. Studies show that breast reconstruction has a significant positive effect on the psychological well-being of breast cancer patients.2,3
There are several different types of breast reconstruction and a variety of surgical techniques. The best treatment plan for each patient will depend on her overall health, the details of her breast cancer surgery, and her personal preferences. Dr. Horton works closely with each of her patients to ensure they are well-educated about their breast reconstruction options and confident in their chosen treatment plan.
"Dear Dr. Horton, Way back in April 2011 you reconstructed my right breast after I had lived with wearing a breast insert for over fifteen years. I can't tell you what a difference you made in my life, and I'm sorry for not writing this sooner! The hospital experience was so great, even though the recovery was rather a lot. But it was all so worth it and your meticulous work left me feeling complete and back to "normal" in a way I couldn't have anticipated. Wearing a bathing suit, "normal" clothes and moving freely are all so great and I still feel grateful to you every time I see myself naked in the mirror. The symmetry is truly a work of art! With so much gratitude, L."
„At your consultation, Dr. Horton discusses your lifestyle, preferences, and goals. She will review your options and answer any and all questions you have before determining which breast reconstruction procedures are most appropriate for you.
Silicone or saline breast implants may be used. Traditional reconstruction is delayed and involves a tissue expander that is gradually filled. Dr. Horton has pioneered single-stage implant reconstruction (prepectoral), where an adjustable saline-filled implant replaces breast tissue at the time of mastectomy or lumpectomy.
Later, implants can be changed to silicone gel if appropriate. Only smooth round devices are used in our office. Full-sized silicone gel breast implants can be placed immediately or years after breast cancer treatment.
Learn more about single-stage breast implant reconstruction.
Alternatively, full-sized silicone gel breast implants can be placed at the same time as a mastectomy or lumpectomy, or years after breast cancer treatment. Only smooth round devices are used in our practice. To learn more, visit our blog posts on breast implants and view our before and after galleries!
Flap reconstruction uses your own tissue for a more natural breast look and feel. In some cases, tissue can also be harvested from the buttocks as an alternative donor site. These advanced free flap procedures require microsurgical expertise. Dr. Horton is skilled in microsurgery, which is required for these advanced techniques.
Choosing the right tissue flap technique depends on anatomy, previous treatments, and patient goals.The success of flap reconstruction depends heavily on preserving adequate blood supply to the transferred tissue. Learn more about flap procedures and which part of your body may be used as a donor site.
Some mastectomy patients have a nipple-sparing procedure, but nipple reconstruction is an option for those who do not. NAC (nipple and areolar complex) reconstruction is typically performed several months after breast reconstruction and helps to complete a natural-looking appearance.
Learn more about nipple reconstruction
There is no “best breast reconstruction method” – there is only what is best for your unique body, history, needs and goals. Single stage implant reconstruction can be a good choice for patients who have small tumors, as well as those who have preventative mastectomies. Patients who are not candidates for single-stage reconstruction may still be able to have reconstruction with implants if that meets their goals. Flap reconstruction is often better suited to women who have naturally large breasts, as well as those who would prefer to use their own tissue, so long as they have sufficient “donor site” tissue. Working together with her patients and using shared-decision making, Dr. Horton helps her patients individually determine what type of reconstruction – or whether a combination of techniques – is best for them.
An immediate reconstruction is a single surgery that includes both mastectomy and reconstruction done at the same surgery. Our practice refers to local Breast Surgeons who are experts in nipple-sparing mastectomy and who also consider the aesthetic results to be paramount as a surgical goal. Many patients are candidates for immediate reconstruction, which offers the benefit of a single surgery date and natural-looking results without a waiting period for tissue expansion before their final reconstruction. In most cases, immediate reconstruction is combined with a nipple-sparing mastectomy.
Delayed reconstruction involves a waiting period between mastectomy and reconstruction. Delayed reconstruction may be recommended in cases where there are complex medical concerns, such as rapidly growing tumors, as well cases in which the patient prefers to delay reconstruction for personal reasons. It is recommended that at least 6 months pass after the end of radiation before breast reconstruction, and at least 6 weeks after chemotherapy ends before having surgery.
As a breast cancer survivor, Dr. Horton helped ease my transition to the 'new normal' with a beautiful new breast. She is a caring woman and skilled artist. I am whole again.
„In this video, Dr. Horton’s patient, Allison, discusses her choice to undergo reconstructive surgery after breast cancer treatment. She touches upon life before and after the surgery, and how she is able to do everything now that she could do before having the procedure with a renewed feeling of confidence.
Breast reconstruction can be viewed as an opportunity, and we aim to make the reconstructive process a rewarding and positive experience for each of our patients facing breast cancer. Evaluate what your personal goals are for breast reconstruction. Collect photographs of “wish pictures” of how you would like your breasts to look after surgery – this may not always be possible, but bringing photos will help facilitate discussions about your goals and ensure you are on the same page with your surgeon! Make a wish list for your goals and jot down questions to bring with you to your consultation and preoperative visit so that we can best answer your questions, address your concerns and together determine which procedure(s) will best achieve your goals. Also, please bring a loved one or trusted friend. with you to your consultation as well. Having another pair of ears is always helpful when you are learning about your options for breast reconstruction.
If you’re taking a GLP-1 medication for diabetes or weight loss, it’s important to pause treatment at least one month before undergoing any procedure with general anesthesia. To better understand how to prepare safely, including guidance on semaglutides, please read this blog post.
Recovery may range from weeks to a year, depending on the type of flap surgery or implant reconstruction. Arrange for support during recovery. We recommend the ASPS Breast Reconstruction Recovery Planner as a useful health care tool for patients preparing for surgery.
Consistent follow-up appointments help ensure optimal healing and results. We schedule regular visits after surgery to monitor wound healing, teach scar therapy and assess early and long-term outcomes.
I can only say Dr Horton completely changed my life. I had numerous unsuccessful surgeries before finally meeting Dr Horton. I was a 2 time cancer survivor and the radiation from my initial diagnosis had caused substantial damage and made reconstruction very difficult. I had unsuccessful breast reconstruction after my bilateral mastectomy at UCSF. She patiently talked to me about options and gave me the bad news that my body would need to heal for a year from the ongoing infection I had from my surgeries with my prior doctor. She told me what I needed to hear, not what I wanted to hear. I had numerous stages to my reconstruction. Dr Horton and I talked about how there would be a number of steps needed, for my initial surgery with her I underwent a free flap surgery. She was with me every step of the way. She gave me her cell phone number and called me immediately if I texted or left a message. She was always there to assure me when I was concerned. I am sad to see the negative comments. I am confident that Dr Horton never told anyone that all they would need is one surgery. No doctor can guarantee results nor outcomes. Every person is different and their bodies respond differently. I had to have additional surgeries due to healing issues which had nothing to do with Dr Horton, it was my body responding and it was still struggling with the radiation after effects. I also had implants put in under the flaps in a secondary surgery due to issues with my breast bone. ( again my body issue, not Dr Horton) She gave me a “makeover” and I am so happy with the outcome. I look and feel better than I have in 20 years! I sent one of my best friends to Dr Horton when she was diagnosed with Breast Cancer. She loved Dr Horton and had the same amazing experience that I did. The preponderance of comments are positive and reflect who Dr Horton really is. I have, and will continue, to recommend her. She is truly the best.
At the age of 35, I was diagnosed with HER-2 positive breast cancer. It was both frightening and devastating. Although I received treatment at UCSF, I wanted a private surgeon for my bi-lateral mastectomy. The decision to have a mastectomy over a lumpectomy was a fairly easy one for me as my mother had breast cancer and I'm aware the younger you are, the longer you have to go without recurrence. I had my work cut out for me when looking into which plastic surgeon to go with. I work for a data and security company and research is one of my main strengths. I went to 6 plastic surgeons in San Francisco, Marin County and in the Stanford/Palo Alto area. I cross examined them and came to the conclusion that Dr. Horton would be my plastic surgeon. I preferred the implant to be over the muscle as I'm very athletic and didn't want to lose any upper body strength. I also didn't want the flex seen when the implant is put under the muscle. The first part of the mastectomy was done in Feb 2017 when the tissue expanders were put into place. I then saw Dr. Horton 6-7 more times before the second surgery for the final implants in August 2017. The whole procedure could not have gone better. The results are beautiful. Dr. Karen Horton was amazing to work with and I would highly recommend her to anyone who wants great results while going through the (unfortunate) process of a bi-lateral mastectomy and reconstruction. Of all of the doctors who assisted during my breast cancer journey, Dr. Horton was one of the best. She was a true advocate and I can say that the breast cancer did not get the final say on how I feel about myself as a woman and as a survivor. I feel great today about my breasts and I hope other women are given the same opportunity I was in finding the right providers.
*Individual Results May Vary
Watch this video of a breast reconstruction patient’s experience over a full year of treatment. She underwent bilateral nipple-sparing mastectomies, immediate single-stage implant reconstructions, followed by chemotherapy and radiation therapy. This strong, brave woman and her supportive husband created this video on their own to share with others, and to demonstrate how she remains an empowered, bold, beautiful breast cancer survivor! Click on the box on the lower right of the video to make the slideshow larger to and to be able to read the text that accompanies her slides.
Does insurance cover breast reconstruction surgery?
Yes, there are laws in place that protect a patient's right to mastectomy or lumpectomy as well as breast reconstruction. Your insurance plan should offer coverage for your choice of breast reconstruction procedure. If you have a mastectomy or lumpectomy only on a single breast, you are also entitled to have an aesthetic procedure on the other breast if it is necessary for symmetry. Our office is no longer a Participating Provider for insurance; we can provide a financial quote for what anticipated surgical fees will be after your consultation.
What if I already had breast reconstruction but I’m unhappy with my results?
You deserve to feel comfortable and beautiful in your skin. If you are dissatisfied with the results of your previous reconstruction or your breasts are lacking symmetry, you may be a candidate for a breast revision procedure. Dr. Horton is skilled and experienced in complex Revision Breast Surgery to help create more symmetric, beautiful, and natural-looking results.
Can I have Breast Reconstruction before or after Chemotherapy or Radiation?
How much does breast reconstruction cost?
How much does breast reconstruction cost? Your personal financial responsibility for surgery depends on the specifics of your insurance plan and whether your surgeon is a Provider for your particular plan. Our Patient Coordinator will go over this with you in detail as we plan your surgery and will assist you in using your insurance to your greatest advantage.
Are there any risks associated with breast reconstruction surgery?
Any surgical procedure carries some risk of complications or side effects, but patients usually find that the benefits of breast reconstruction outweigh its potential risks. Possible complications include infection, bleeding and poor healing with unsightly scars; flap procedures carry a risk of tissue loss and implant procedures carry a risk of capsular contracture and implant-related illnesses.22 Dr. Horton prioritizes patient safety, she educates her patients fully about their potential risks and complications at each visit, and takes every precaution necessary to help minimize the chance of complications.
How do I choose a surgeon for breast reconstruction surgery?
Breast reconstruction is a highly personal decision. You deserve a Surgeon who is not only qualified, but also respects your journey. Dr. Karen Horton is Board Certified, highly experienced in breast reconstruction and known for personalized treatment and beautiful, natural-looking results. She is also an advocate for breast cancer patients and an active participant in Breast Reconstruction Awareness Day.
Where can I find breast reconstruction near me?
Dr. Karen Horton offers personalized breast reconstruction care in San Francisco, California. Patients seeking expert breast reconstruction near me benefit from her advanced techniques and patient-first philosophy.
Thank you so much for the support and care you have provided me. All of you are wonderful angels in the darkness that is BRCA/breast cancer.
„
1 American Society of Plastic Surgeons. What is breast reconstruction? Available: https://www.plasticsurgery.org/reconstructive-procedures/breast-reconstruction. Accessed July 14, 2026.
2 Shiraishi M, Sowa Y, Tsuge I, Kodama T, Inafuku N, Morimoto N. Long-Term Patient Satisfaction and Quality of Life Following Breast Reconstruction Using the BREAST-Q: A Prospective Cohort Study. Front Oncol. 2022 May 23;12:815498. doi: 10.3389/fonc.2022.815498. PMID: 35692774; PMCID: PMC9178786. Available: https://pmc.ncbi.nlm.nih.gov/articles/PMC9178786/. Accessed July 14, 2025.
3 Siqueira HFF, Teixeira JLA, Lessa Filho RDS, Hora EC, Brasileiro FF, Borges KS, Brito ÉAC, Lima MS, Marques AD, Moura AR, Figueiredo Júnior TC, de Oliveira TC, Vasconcelos AAS, Lima CA. Patient satisfaction and quality of life in breast reconstruction: assessment of outcomes of immediate, delayed, and nonreconstruction. BMC Res Notes. 2020 Apr 19;13(1):223. doi: 10.1186/s13104-020-05058-6. PMID: 32307018; PMCID: PMC7169023. Available: https://pmc.ncbi.nlm.nih.gov/articles/PMC7169023/. Accessed July 14, 2025.
Dr. Karen Horton has either authored or reviewed and approved this content.
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Dr. Karen M. Horton
2100 Webster St., Suite 520
San Francisco, CA 94115
Phone: 415.923.3067
We are located in the Pacific Heights District in the Pacific Professional Building.
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Saturday-Sunday: Closed
Monday:
9 AM to 5 PM
Tuesday:
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Wednesday:
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Thursday:
9 AM to 5 PM
Friday:
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Saturday:
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Sunday:
Closed
Dr. Karen M. Horton
2100 Webster St., Suite 520
San Francisco, CA 94115
Phone: 415.923.3067
We are located in the
Pacific Heights District
in the Pacific Professional Building.
SHOP SKIN CARE
*Please note: Our office is no longer a Participating Provider for insurance. We can provide a financial quote for what anticipated surgical fees will be after your consultation.
