Direct-To-Implant Breast Reconstruction

Breast Reconstruction


Direct-to-Implant Breast reconstruction allows for the breasts to be reconstructed at the same time as a mastectomy. The surgery is performed through a small incision hidden in the crease below the breast. Unlike traditional reconstruction, the implant is placed at the same time as the mastectomy.

Avoid Tissue Expansion

Direct-to-implant breast reconstruction minimizes discomfort and eliminates the need for patients to endure months of painful tissue expanders.


This procedure gives women beautiful breasts. In fact, many of our patients say that they like their new, reconstructed breasts more than their prior breasts. 

New Breasts In One Surgery

This breast reconstruction procedure is done during the same surgery as the mastectomy, so that patients wake up from surgery with their new breasts. Formerly, breast reconstruction was performed in stages. After mastectomy, a flat, fillable type of implant, called a tissue expander was placed. Over time, this expander was filled and then replaced with breast implants at a later date.

What Is Unique About Direct-To-Implant Procedure?

“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.


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. Dr. Cassileth uses 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. Dr. Cassileth’s 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.

Who Is A Good Candidate for Direct-To-Implant Breast Reconstruction?

Most patients are good candidates for this procedure, which treats size A to size DD breasts. Breasts that are droopy are often also suitable for this procedure. The procedure gives a natural lift to the breast as the heavy breast is removed, and then the skin springs up to the new supported implant.

Prepectoral Breast Implant Placement

Cassileth Plastic Surgery has pioneered many techniques in breast reconstruction. Dr. Cassileth and Dr. Killeen conduct a detailed examination and have a thorough conversation with with each patient to decide implant size, incision type, and implant placement. The breast reconstruction procedure is hand tailored to each patient. The exact procedure details and implant placement location is determined on a case by case basis.

Women undergoing breast reconstruction now have the option to have the implants placed over the muscle. The benefits of prepectoral breast implant placement (placing the implant over the muscle) include: less muscle movement, a more comfortable outcome, and less altering of the normal breast structure.

To support prepectoral breast implants, breast specialists Dr. Cassileth and Dr. Killeen create an internal bra using acellular dermal matrix (ADM). The breast specialists of Cassileth Plastic Surgery, have used ADM for over a decade in both breast reconstruction and capsular contracture treatment and repair.

Who Is A Good Candidate For Prepectoral Breast Implant Placement?

Patients are a good candidate for patients who wish to avoid any discomfort or tightness after breast reconstruction surgery using an implant placed under the muscle. Patients opting to undergo fat grafting in addition to using a breast implant are also ideal candidates for this type of placement.



With more women than ever choosing to undergo mastectomy for the treatment or prevention of breast cancer, the desire for a better type of reconstruction has grown. Dr. Lisa Cassileth’s innovative technique allows women to awaken from mastectomy surgery with intact breasts, and minimal or no scarring.

Cassileth Plastic Surgery performs over 200 breast reconstructive cases per year. This includes nipple reconstruction, reconstruction implant revisions, and fat grafting. More than half of those 200 cases are primary breast reconstruction done at the time of the mastectomy in our Beverly Hills, CA surgery center.




Board Certified Beverly Hills Plastic Surgeon, Breast Specialist, and Direct-To-Implant Breast Reconstruction Inventor 


Double-Board Certified Beverly Hills Plastic Surgeon and Breast & Body Specialist