Case #1202
Direct-to-Implant Reconstruction
49-year-old female with multiple cysts of her bilateral breasts that were both uncomfortable and distoring. She underwent prophylactic nipple-sparing mastectomy and Dr. Azadgoli performed single stage reconstruction with 265cc moderate profile implants.
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.
- Stop NSAIDs, aspirin, and high-dose fish oil two weeks before surgery; the surgical team provides a full medication list at the pre-op visit.
- No nicotine for 6 weeks before through 6 weeks after surgery. The vascular impact directly affects skin healing.
- Front-closing clothing only for 3 weeks. Drain holders and supportive surgical bras are issued at discharge.
- Day-of transport and an overnight companion (24 hours minimum) are required for discharge.
Recovery timeline
Milestones specific to this case. Individual recovery varies.
- Day 1–7
Both sides healing in parallel means the early phase is quieter — short walks, full rest periods, and no driving until off pain medication.
- 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
Shape is 80–90 percent of final. Scars are still pink and will continue to lighten through month 12.
Continued care
Recommended aftercare, skincare, and MedSpa services for Direct-to-Implant Reconstruction.
- Compression bra continuously for 6 weeks
- Drain care taught before discharge; removed when output is low (typically 1–2 weeks)
- Sleep elevated on your back for 2 weeks
- No lifting above 10 lb for the first 3 weeks
- Follow-up imaging coordinated with the oncology team
- Medical-grade silicone sheeting on the mastectomy incision
- SkinCeuticals C E Ferulic for scar healing
- SPF 50+ on incisions for 12 months
- Priority lymphatic drainage starting week 1
- LED light therapy weekly for the first 8 weeks
- Fractional laser for scar refinement after 3 months
- Aftercare
Hyperbaric oxygen series extended to 10–15 sessions for bilateral tissue support.
Bilateral procedures heal more reliably with sustained HBOT.
