Case #1354 · San Matteo, CA
Direct-to-Implant Reconstruction
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This 42-year-old patient from San Matteo, CA was BRCA positive and opted for preventative bilateral mastectomy with one-stage reconstruction by Dr. Cassileth. She desired to have fuller breasts, Dr. Cassileth performed a fat grafting breast augmentati
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
- Aftercare
Bilateral HBOT protocol, 10–15 sessions over the first 6 weeks.
Bilateral procedures heal more reliably with sustained HBOT.
- Coordination
Long-term risk plan reviewed with genetic counseling, scheduled if not already established.
BRCA+ patients benefit from coordinated long-term risk planning.
Why this approach
The decisions that shaped this surgical plan.
- Both sides treated in the same session, symmetric planning, identical tissue handling, and matched final contour are easier to achieve in one operative window than in two.
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.
- 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.
- A driver is required the day of surgery and a responsible adult should stay with you the first 24 hours.
Recovery timeline
Milestones specific to this case. Individual recovery varies.
- Day 1–7
Bilateral healing takes a slower start. Expect more chest-wall fatigue through day 5 and a stricter no-lifting rule for the first 10 days.
- 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
Shape is 80–90 percent of final. Scars are still pink and will continue to lighten through month 12.
“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
