Case #1396 · Venice, California
Breast Reconstruction Revision
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This 49-year-old patient from Venice, California had previous TRAM flap surgery with another surgeon. She desired improvement in the appearance of her reconstructed breasts. Her first surgery with Dr. Cassileth consisted of a right breast implant plac
Continued care
Recommended aftercare, skincare, and MedSpa services for Breast Reconstruction Revision.
- Compression bra continuously for 6 weeks
- Sleep elevated on your back for 2 weeks
- Hyperbaric oxygen therapy when recommended — common in revision and post-radiation tissue
- Scar management at 3 weeks; aggressive protocol for revision sites
- Medical-grade silicone sheeting on revised scar lines
- SkinCeuticals C E Ferulic for scar healing
- SPF 50+ on incisions for 12 months
- Laser or microneedling for revision scar refinement after 3 months
- Indiba radiofrequency for tissue recovery
- LED light therapy weekly for the first 8 weeks
- Aftercare
Revision protocol pushes scar work out by 14 days vs. the primary-case schedule.
Revised tissue tolerates active treatment less well than primary cases.
- Skincare
Scar plan combines silicone sheeting plus topical tape for sustained pressure.
Revised scars respond best to sustained, layered pressure therapy.
Why this approach
The decisions that shaped this surgical plan.
- Revision planning starts with the previous result. Existing scars, tissue thickness, and the original technique determine what can be improved and what is locked.
- 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.
- 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
Light activity, hydration, and elevation. Expect peak swelling between days 3 and 5, then a gradual easing through the end of the week.
- 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
Most patients consider this the "final result emerges" milestone. The remaining 10 percent of refinement plays out through month 6.
- Month 6
Final shape continues to settle. Revised areas commonly look their best between months 9 and 12.
