Case #1294 · Venice, CA
Direct-to-Implant Reconstruction
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This 34-year-old-patient from Venice, CA was BRCA1 positive. She underwent prophylactic bilateral mastectomy and during the same surgery Dr. Cassileth performed one-stage breast reconstruction.
Continued care
Recommended aftercare, skincare, and MedSpa services for Direct-to-Implant Reconstruction.
- Lymphatic drainage massage starting week 2
- Compression garment for 4–6 weeks
- Scar management protocol at 3 weeks
- Hyperbaric oxygen therapy to raise tissue oxygen and support skin and incision healing, particularly with prior radiation or a compromised blood supply
- SkinCeuticals C E Ferulic for scar healing
- Medical-grade silicone sheeting
- SPF 50+ on incision sites
- Laser or microneedling for scar refinement after 3 months
- LED light therapy to accelerate healing
- Indiba radiofrequency for tissue recovery
- Aftercare
Bilateral HBOT protocol, 10–15 sessions over the first 6 weeks.
Bilateral procedures heal more reliably with sustained HBOT.
- Coordination
Genetic counseling coordination through the wellness team if not already in place.
BRCA+ patients benefit from coordinated long-term risk planning.
- Skincare
SPF 50+ on incisions daily for the first year; younger skin pigments scars more reliably under UV.
Younger skin pigments scars more reliably under sun exposure.
Why this approach
The decisions that shaped this surgical plan.
- Bilateral direct-to-implant performed in one operative session so symmetry, tissue handling, and final shape track between both sides.
Pre-op preparation
What to do before surgery. Specific to this case.
- Aspirin, ibuprofen, vitamin E, and fish oil discontinued 14 days pre-op to reduce bruising risk. Acetaminophen is allowed.
- No nicotine for 6 weeks before through 6 weeks after surgery. The vascular impact directly affects skin healing.
- Arrange button-front or zip-front tops for the first three weeks, overhead reaching is restricted. A drain holder or apron is provided.
- Confirm a driver for surgery day and a companion who can stay through the first night.
Recovery timeline
Milestones specific to this case. Individual recovery varies.
- Day 1–7
Both sides healing in parallel means the early phase is quieter, short walks, full rest periods, and no driving until off pain medication.
- Week 2
Patients off prescription pain medication, walking 1–2 miles daily, and back to most light household activity.
- Week 4
Most patients back to gym cardio at 50 percent intensity. Scar massage protocol begins. Driving restored if not already.
- Week 6
Standard clearance milestone. Patients return to most exercise, gym work, and sleeping in any position.
- Month 3
Shape is 80–90 percent of final. Scars are still pink and will continue to lighten through month 12.
“Reconstructing the breasts at the same time as mastectomy eliminates the risks of multiple surgeries and, more importantly, helps minimize the sense of loss.”
Dr. Lisa Cassileth
