"It's exciting and rewarding to provide a new choice for breast cancer patients who are undergoing mastectomy. Reconstructing the breasts at the same time eliminates the risks of multiple surgeries and, more importantly, helps minimize the sense of loss." - Dr. Lisa B. Cassileth, Board Certified Plastic Surgeon
Age: 40, from San Clemente, California. Underwent bilateral skin-sparing mastectomy with Cassileth One-Stage/Direct to Implant Breast Reconstruction. The patient had nipple/areola reconstruction as a second surgery and had a tummy tuck as a separate procedure. 397cc implants.
Dr. Cassileth is not only an incredibly talented surgeon, she is also an angel. She helped me through my breast cancer journey, and I came out looking beautiful! Her one step mastectomy was life changing for me. I beat breast cancer, and thanks to Dr. Cassileth, I looked great doing it!"
Dr Killeen has truly been one of the best doctors I have even encountered. Her dedication to her patients, swift responses and caring demeanor make her an outstanding surgeon, not just her amazing results. The kindness and supportive outlook make the actual surgery and healing so much easier. I can't thank Dr Killeen enough! - Sarah S.
Dr. Cassileth with her patient Alyssa who was diagnosed with DCIS breast cancer. This is her story -- from meeting Dr. Cassileth up to during and after her direct to implant breast reconstruction
In Cassileth One-Stage/Direct to Implant Breast Reconstruction breasts are reconstructed at the time of mastectomy, allowing women to wake up from mastectomy surgery with their breasts intact. Incisions are similar to a breast augmentation, and are hidden in the fold under the breast.
We perform over 200 breast reconstructive cases per year! More than half of these are direct to implant breast reconstruction done at the time of the mastectomy, right here in Los Angeles, CA.
"We are so frustrated with the bad-looking results we see. The traditional process is painful, requires multiple surgeries, and gives unattractive outcomes. We are working to change the "standard of care" for breast reconstruction, because women deserve better. We want women to know that newer, better options exist." - Lisa Cassileth, MD FACS
Most plastic surgeons place tissue expanders at the time of mastectomy to stretch the chest muscles and make room for breast implants. Over the next several months, the expanders are inflated using saline injections. Then, in a second surgery, they are removed and replaced with breast implants.
Many women find that breast reconstruction after mastectomy is one of the most demoralizing, difficult, and disappointing parts of breast cancer treatment. It has meant months of chest wall expansion and a mandatory second surgery to swap the expanders for permanent implants. And after two surgeries, patients may be left with reconstructed breasts disfigured by large, unsightly scars.
Now there is a better alternative known as one-stage or direct to implant breast reconstruction.
It starts with a mastectomy performed through a very small incision rather than the large across-the-breast scar that used to be the norm. The breast implant is placed during the mastectomy surgery, eliminating the need for painful and prolonged tissue expander appointments. Our doctors use a natural collagen substance called acellular dermal matrix, or ADM to create an internal bra to support the implant. With this method, the breast can be recreated in a more natural position than typical breast reconstruction, and looks good even immediately after the surgery. Our technique yields a very symmetric cosmetic result, and can produce virtually any desired breast size. The final scar is minimal, or it may even be completely absent. The results are beautiful, natural-looking breasts.
Dr. Cassileth's study on this procedure was published in the Annals of Plastic Surgery: Click to view abstract (PDF)
To learn more about Direct to Implant Breast Reconstruction, see our Frequently Asked Questions.
A study revealed that a nipple sparing mastectomy is as safe as the more radical surgeries. Click to read.
Learn more about how Alloderm® works in this video from LifeCell (the manufacturer):
Getting the right kind of mastectomy is critical. The best results are achieved with either a skin-sparing mastectomy or a nipple/areola-sparing mastectomy. Our breast reconstruction specialists, based at Bedford Breast Center in Los Angeles, perform these types of mastectomies.
For patients with BRCA+*, those with DCIS or LCIS only, and for breast cancer patients where the tumor is not directly adjacent to skin, Skin-Sparing Mastectomy is safe and cosmetically superior to traditional mastectomy.
*BRCA Definition: The BRCA gene test is a blood test that uses DNA analysis to identify harmful changes (mutations) in either one of the two breast cancer susceptibility genes — BRCA1 and BRCA2. Women who have inherited (from a family member) mutations in these genes face a much higher risk of developing breast cancer and ovarian cancer compared with the general population. Often women that test positive for the BRCA gene opt to have bilateral mastectomies and breast reconstruction to prevent possible future breast cancer.
With Skin-Sparing Mastectomy, only the nipple and areola skin are removed. The breast tissue is removed through the hole left by the areola. The reconstruction is then performed through the same small incision. In a later surgery, the nipple and areola are reconstructed, and placed so that the incision is hidden in the areola, producing a scarless result.
The most superior cosmetic results are obtained with the Nipple/Areola-Sparing Mastectomy. Through the crease under the breast, the breast tissue is removed and the breast is reconstructed. Not all patients are candidates for this type of mastectomy reconstruction, as the nipple and areola can contain a small amount of breast ductal tissue. This option is often chosen by women who are deciding between mastectomy and screenings, because they have high risk factors such as BRCA+ or a strong family history of breast cancer. Women who have breast cancer further away from the nipple are also good candidates. All mastectomies are performed at our Beverly Hills Surgery Center with our mastectomy and reconstruction colleagues who are board-certified general surgeons specializing in breast and oncological surgery. Their expertise helps make your single stage breast reconstruction go smoothly with excellent results!
The real clincher is that I had a total mastectomy, and if I were nude on a French beach, you would have no idea. That is just how skillful Dr. Cassileth's surgical technique is. This is due to the ingenious type of mastectomy reconstruction that she pioneered which I hope will become the standard of care for all women over time."
Many of our patients fly in from out of state or visit us from international destinations. Below is some information to explain and help facilitate this process:
We will email you our new patient paperwork or you can download it here. Please complete it and email or fax back to us.
We also request that you fax or email to us your pathology, imaging results, photos, etc. One of our doctors will review your records and assess if you are a good candidate for Cassileth One-Stage/Direct to Implant Breast Reconstruction Surgery.
We can set up a video conference or phone call for you with a doctor. At this time, you will discuss surgery options and we will recommend a general surgeon. Your general surgeon will also be available for a phone conversation or web conference.
Our practice director, Sonya Pasamonte, will give you an estimated cost for the procedures in which you are interested. She will also discuss your insurance coverage. Sonya can provide information on pre-operative care, recovery, local accommodations and answer any other questions related to your procedure and stay in Beverly Hills. If you are traveling from outside the US we highly recommend that you purchase travel insurance.
Once you have booked your surgery you will receive by email your pre-operative instructions and procedure consents. This packet must be read carefully and instructions followed closely. Details of any blood work required and related medical testing will be included in this packet.
Approximately two weeks before your surgery date our physician assistant, Kristen Davis, will contact you by phone or on the web to review your instructions and go over your health history.
After your single stage breast reconstruction surgery, you will stay in the hospital until you are comfortable moving around without assistance. This usually means a two-night stay in the hospital. One of our doctors will see you post-operatively at our office in Beverly Hills. Most patients are able to return home 14 days later. We advise that you make your primary care physician aware of your surgery and that you follow up with him/her once you return home. Your health and safety are our main concern.
Our closest airport is LAX. It is approximately 20-40 minutes from our office depending upon traffic. For a map to our office from LAX click here. You MUST arrive one to two days prior to your surgery date. At a designated time during this period you will meet with both the plastic surgeon and your general surgeon. This is a great opportunity to go over the details of your procedure. Surgical consents will be signed at this time.
Thanks to you I was able to wear a beautiful low-cut wedding gown and showed off my new boobs! We love you for all that you did for me and continue to do for others…Thank you so much! (2 years cancer-free!)"