Case #1267 · Culver City, CA
Direct-to-Implant Reconstruction
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This 36-year-old patient from Culver City, CA had right breast cancer and decided to undergo bilateral mastectomies with Dr. Cassileth's One-Stage Breast Reconstruction. Dr. Cassileth used 410cc shaped implants. She later performed bilateral fat grafting to both breasts as a seco
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
- Coordination
Follow-up imaging schedule coordinated with the oncology team.
Post-mastectomy patients stay on a long-term surveillance pathway.
- Aftercare
Lymphatic drainage prioritized at week 1 to limit post-axillary swelling.
Lymphatic disruption from axillary work makes early drainage more valuable.
- 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.
- Reconstruction planned around the oncologic mastectomy, surgical timing, tissue preservation, and incision pattern were chosen to support both safe cancer clearance and long-term aesthetic outcome.
- Single-side procedure. The non-operated side anchors the symmetry target; technique choice reflects what's needed to match it.
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.
- Nicotine in any form, cigarettes, vapes, patches, gum, paused six weeks before and six weeks after surgery. Nicotine narrows blood vessels and slows wound healing.
- Front-closing clothing only for 3 weeks. Drain holders and supportive surgical bras are issued at discharge.
- A driver is required the day of surgery and a responsible adult should stay with you the first 24 hours.
- Pre-op coordination with the oncology team confirms imaging, biopsy results, and any neoadjuvant timing. The surgical team owns this loop.
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
Walking distance doubles. Showering rules relax. Compression garments transition to the long-wear schedule.
- Week 4
Most patients back to gym cardio at 50 percent intensity. Scar massage protocol begins. Driving restored if not already.
- Week 6
The "back to normal" week for most patients. Final compression schedule transitions to optional.
- Month 3
Coordinated oncology and surgical check-in. Reconstruction shape and feel begin to mature.
- Month 6
Mature result. Patients commonly schedule the final phase of staged reconstruction here.
“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
