Case #1314 · Los Angeles, CA
Direct-to-Implant Reconstruction
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This 48-year-old patient from Los Angeles, CA was diagnosed with breast cancer in her right breast. Following her bilateral mastectomy, Dr. Cassileth performed immediate breast reconstruction using 210 cc silicone implants and bilateral nerve graft to restore sensation. Patient r
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
Long-term surveillance imaging stays on the oncology pathway; our team coordinates timing with theirs.
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.
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.
- Surgical plan calibrated against the opposite side. Final shape, scar position, and volume targeted to match, not to a generic ideal.
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.
- No overhead clothing for 3 weeks. Stock front-zip tops, supportive sports bras (post-clearance), and the drain pouches we provide.
- 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
First week prioritizes drain care, walking short distances, and avoiding any overhead reaching. Multi-modal pain control keeps narcotic use brief.
- Week 2
Walking distance doubles. Showering rules relax. Compression garments transition to the long-wear schedule.
- Week 4
Return to most low-impact activity. Scar massage, compression, and skincare protocols pick up.
- 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
