Case #1353 · Calabasas, CA
Direct-to-Implant Reconstruction
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This 41-year-old patient from Calabasas, CA presented invasive ductal carcinoma in the left breast. She underwent a bilateral mastectomy with direct-to-implant breast reconstruction. Dr. Cassileth placed 240 cc silicone implants over-the-muscle and acellular dermal matrix for sup
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
Priority lymphatic drainage starting week 1.
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.
- 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.
- Full nicotine cessation 6 weeks pre- and post-op. This includes vapes and nicotine replacement products; the constriction effect is the same.
- Arrange button-front or zip-front tops for the first three weeks, overhead reaching is restricted. A drain holder or apron is provided.
- Confirm a driver for surgery day and a companion who can stay through the first night.
- 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
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
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
