Case #1332 · Pacific Palisades, CA
Direct-to-Implant Reconstruction
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This 50-year-old patient from Pacific Palisades, CA was diagnosed with breast cancer in her left breast. She underwent a bilateral mastectomy, and Dr. Cassileth performed direct-to-implant breast reconstruction placing 485cc silicone implants and using an absorbable mesh for supp
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
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.
- 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.
- Unilateral case, the contralateral side was reviewed pre-op for symmetry goals. The technique was selected to match the untreated side in volume, shape, and position.
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.
- No nicotine for 6 weeks before through 6 weeks after surgery. The vascular impact directly affects skin healing.
- Arrange button-front or zip-front tops for the first three weeks, overhead reaching is restricted. A drain holder or apron is provided.
- Day-of transport and an overnight companion (24 hours minimum) are required for discharge.
- Surgical date confirmed against oncology pathway. Imaging and pathology results are reconciled by the team at the pre-op visit.
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
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
