Revolutionizing care for breast cancer patients:
Cassileth One-Stage Breast Reconstruction

Dr. Cassileth’s technique allows your breasts to be reconstructed at the time of mastectomy in one single surgery.

"It's exciting and rewarding to provide a new choice for breast cancer patients who are undergoing mastectomy. Reconstructing the breasts at the same time eliminates the risks of multiple surgeries and, more importantly, helps minimize the sense of loss."

With more women than ever choosing to undergo mastectomy for the treatment or prevention of breast cancer, the desire for a better type of reconstruction has grown. Dr. Cassileth's innovative technique allows women to awaken from mastectomy surgery with intact breasts, and minimal or no scarring.

Dr. Cassileth performs over 200 breast reconstructive cases per year!! This includes nipple reconstruction, reconstruction implant revisions, and fat grafting. More than half of those 200 cases are primary breast reconstructions done at the time of the mastectomy.

The Current Standard of Care

Most plastic surgeons place tissue expanders at the time of mastectomy to stretch the chest muscles and make room for breast implants. Over the next several months, the expanders are inflated using saline injections. Then, in a second surgery, they are removed and replaced with breast implants.

Many women find that breast reconstruction after mastectomy is one of the most demoralizing, difficult, and disappointing parts of breast cancer treatment. It has meant months of chest wall expansion and a mandatory second surgery to swap the expanders for permanent implants. And after two surgeries, patients may be left with reconstructed breasts disfigured by large, unsightly scars. Here is an example of the results of traditional, tissue-expander-based reconstruction:
Source: American Society of Plastic Surgeons

Now there is a better alternative:
Cassileth One-Stage Breast Reconstruction

Dr. Cassileth's study was published in the Annals of Plastic Surgery:
Click to view abstract (pdf)
It starts with a mastectomy performed through a very small incision rather than the large across-the-breast scar that used to be the norm. The breast implant is placed during the mastectomy surgery, eliminating the need for painful and prolonged tissue expander appointments. Dr. Cassileth uses a natural collagen substance called Alloderm to create an Internal Bra to support the implant. With this method, the breast can be recreated in a more natural position than typical reconstruction, and looks good even immediately after the surgery. Dr. Cassileth's technique yields a very symmetrical cosmetic result, and can produce virtually any desired breast size. The final scar is minimal, or it may even be completely absent. The results are beautiful, natural-looking breasts.

The Advantages of Cassileth One-Stage Implant Reconstruction

- Only one surgery – lowers overall risk, decreases cost, and minimizes discomfort
- Avoids months of painful tissue expansion
- >When you wake up from your mastectomy surgery, you will have whole breasts
- The risks are the same or better than traditional tissue expander technique
- Patients enjoy beautiful new breasts that look natural and full

Getting the right mastectomy

Getting the right kind of mastectomy is critical. The best results are achieved with either a skin-sparing mastectomy or a nipple/areola-sparing mastectomy. Our team of specialists, based at Cedars-Sinai Medical Center in Los Angeles, and Saint John’s Health Center in Santa Monica, perform these types of mastectomies.

Skin-Sparing Mastectomy
For patients with BRCA+, those with DCIS or LCIS only, and for breast cancer patients where the tumor is not directly adjacent to skin, Skin-Sparing Mastectomy is safe and cosmetically superior to traditional mastectomy.
With Skin-Sparing Mastectomy, only the nipple and areola skin are removed. The breast tissue is removed through the hole left by the areola. The reconstruction is then performed through the same small incision. In a later surgery, the nipple and areola are reconstructed, and placed so that the incision is hidden in the areola, producing a scarless result.

Nipple/Areola-Sparing Mastectomy
The most superior cosmetic results are obtained with the Nipple/Areola-Sparing Mastectomy. Through the crease under the breast, the breast tissue is removed and the breast is reconstructed. Not all patients are candidates for this type of mastectomy, as the nipple and areola can contain a small amount of breast ductal tissue. This option is often chosen by women who are deciding between mastectomy and screenings, because they have high risk factors such as BRCA+ or a strong family history of breast cancer. Women who have breast cancer further away from the nipple are also good candidates. All mastectomies are performed at a local Los Angeles hospital with Dr. Cassileth's colleagues who are board-certified general surgeons specializing in breast and oncological surgery.

Flying in for breast reconstruction surgery

Many of our patients fly in from out of state or visit us from international destinations. Below is some information to explain and help facilitate this process:

We will email you our new patient paperwork or you can download it here. Please complete it and email or fax back to us.

We also request that you fax or email to us your pathology, imaging results, photos, etc. Dr. Cassileth will review your records and assess if you are a good candidate for Cassileth One-Stage Implant Reconstruction Surgery.
We can set up a video conference or phone call for you with Dr. Cassileth. At this time, you will discuss surgery options and we will recommend a general surgeon. Your general surgeon will also be available for a phone conversation or web conference.

Our practice director, Sonya Pasamonte, will give you an estimated cost for the procedures in which you are interested. She will also discuss your insurance coverage. Sonya can provide information on pre-operative care, recovery, local accommodations and answer any other questions related to your procedure and stay in Beverly Hills. If you are traveling from outside the US we highly recommend that you purchase travel insurance.

Scheduling your procedure

Once you have decided to proceed, a 30% deposit is required to reserve your surgery date. This becomes non-refundable after 48 hours. The balance for your surgery is due two weeks before your surgery date. We accept the following payment options; Cash, cashier's check, international money transfer, Visa, American Express, Mastercard, Discover. Finance options are available through Care Credit. Visit www.carecredit.com

Once you have booked your surgery you will receive by email your pre-operative instructions and procedure consents. This packet must be read carefully and instructions followed closely. Details of any blood work required and related medical testing will be included in this packet.

Approximately two weeks before your surgery date our physician's assistant, Kristin Polega, will contact you by phone or on the web to review your instructions and go over your health history.

What to expect after your surgery

After your surgery, you will stay in the hospital until you are comfortable moving around without assistance. This usually means a two-night stay in the hospital. Dr. Cassileth will see you post-operatively at our office. Most patients are able to return home 14 days later. We advise that you make your primary care physician aware of your surgery and that you follow up with him/her once you return home. Your health and safety are our main concern.

Flying in to local airports

- Los Angeles International Airport (LAX)
- Burbank (BUR)
- Orange County (SNA)
- Long Beach (LGB)

Our closest airport is LAX. It is approximately 20-40 minutes from our office depending upon traffic. For a map to our office from LAX click here. You MUST arrive one to two days prior to your surgery date. At a designated time during this period you will meet with both Dr. Cassileth and your general surgeon. This is a great opportunity to go over the details of your procedure. Surgical consents will be signed at this time.

Local hotel accommodations:

- Residence Inn Marriott Hotel– A great option with a full kitchen in every room.
- The Luxe Hotel Beverly Hills – A boutique hotel within walking distance of our office.
- The SLS Hotel - The ultimate in chic
- The Beverly Wilshire - The elegant hotel featured in the film Pretty Woman.

BRCA Definition: The BRCA gene test is a blood test that uses DNA analysis to identify harmful changes (mutations) in either one of the two breast cancer susceptibility genes — BRCA1 and BRCA2. Women who have inherited (from a family member) mutations in these genes face a much higher risk of developing breast cancer and ovarian cancer compared with the general population. Often women that test positive for the BRCA gene opt to have bilateral mastectomies and breast reconstruction to prevent possible future breast cancer.