Case #1298 · Burbank, CA
Direct-to-Implant Reconstruction
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This 56-year-old patient from Burbank, CA was diagnosed with being high risk for developing breast cancer. She underwent bilateral nipple-sparing mastectomy. During the same procedure Dr. Cassileth performed one-stage breast reconstruction using 410cc silicone implants and bilate
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
Hyperbaric oxygen series extended to 10–15 sessions for bilateral tissue support.
Bilateral procedures heal more reliably with sustained HBOT.
- Coordination
Imaging cadence reviewed against the oncology plan at the 3-month visit.
Post-mastectomy patients stay on a long-term surveillance pathway.
- Aftercare
Priority lymphatic drainage starting week 1.
Lymphatic disruption from axillary work makes early drainage more valuable.
Why this approach
The decisions that shaped this surgical plan.
- Approach driven by the oncologic priority first: incisions and tissue handling chosen to give the oncology team the access they need, then to set up the cleanest reconstructive canvas.
- 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.
- Discontinue blood thinners (NSAIDs, aspirin, fish oil, vitamin E) two weeks out. Acetaminophen remains safe; the full list is reviewed at pre-op.
- No nicotine for 6 weeks before through 6 weeks after surgery. The vascular impact directly affects skin healing.
- No overhead clothing for 3 weeks. Stock front-zip tops, supportive sports bras (post-clearance), and the drain pouches we provide.
- Confirm a driver for surgery day and a companion who can stay through the first night.
- Oncology results, imaging, and any chemotherapy timing reviewed in the pre-op visit. All coordination is handled in-house.
Recovery timeline
Milestones specific to this case. Individual recovery varies.
- Day 1–7
Drains in place, restricted lifting (nothing over 5 lb), and rest. Pain management is shifted off narcotics within the first 72 hours when possible.
- Week 2
Patients off prescription pain medication, walking 1–2 miles daily, and back to most light household activity.
- Week 4
Light cardio and most desk-work activities cleared. Lifting limit increases to 15 lb. Scar massage typically starts now.
- Week 6
Most physical restrictions lift. Return to strength training, full-impact cardio, and overhead lifting.
- Month 3
First major reconstruction assessment. Tissue softens, surveillance imaging if indicated coordinates here.
- Month 6
Final aesthetic emerges. Last-mile adjustments (fat grafting, nipple reconstruction) typically scheduled now.
“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
