Case #1302 · Thousand Oaks, CA
Direct-to-Implant Reconstruction
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This 52-year-old patient from Thousand Oaks, CA underwent bilateral skin-sparing mastectomy and one- stage breast reconstruction with shaped implants and ADM
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
Follow-up imaging schedule coordinated with the oncology team.
Post-mastectomy patients stay on a long-term surveillance pathway.
- Aftercare
Early lymphatic massage protocol initiated in the first week of recovery.
Lymphatic disruption from axillary work makes early drainage more valuable.
Why this approach
The decisions that shaped this surgical plan.
- Oncology and reconstruction planned together rather than in sequence, the mastectomy pattern was selected to leave the best possible foundation for the reconstructive technique that followed.
- Bilateral approach chosen to keep the planning, the tissue response, and the aesthetic outcome consistent between sides.
Pre-op preparation
What to do before surgery. Specific to this case.
- Stop NSAIDs, aspirin, and high-dose fish oil two weeks before surgery; the surgical team provides a full medication list at the pre-op visit.
- Full nicotine cessation 6 weeks pre- and post-op. This includes vapes and nicotine replacement products; the constriction effect is the same.
- Front-closing clothing only for 3 weeks. Drain holders and supportive surgical bras are issued at discharge.
- Day-of transport and an overnight companion (24 hours minimum) are required for discharge.
- 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
Drain care, low-lift movement, and rest through the first week. Nerve blocks (Exparel) cover the worst of the pain through day 3.
- 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
Oncology follow-up timed with the surgical check. Tissue settled enough to assess reconstruction symmetry.
- Month 6
Reconstruction or combo result reaches its mature appearance. Any planned refinement step is timed for this window.
“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
