Case #1316 · Woodland Hills, CA
Direct-to-Implant Reconstruction
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This 59-year-old patient from Woodland Hills, CA was diagnosed with breast cancer in the left breast. She decided to have a bilateral mastectomy with one-stage breast reconstruction performed by Dr. Cassileth using 405cc silicone b
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.
- 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.
- 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.
- Aspirin, ibuprofen, vitamin E, and fish oil discontinued 14 days pre-op to reduce bruising risk. Acetaminophen is allowed.
- 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.
- 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
Activity ramps up cautiously: longer walks, no lifting yet. Most patients return to desk work this week.
- Week 4
Light cardio and most desk-work activities cleared. Lifting limit increases to 15 lb. Scar massage typically starts now.
- 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
