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SWIM Flap Breast Reconstruction

A Revolutionary No-Implant Breast Reconstruction

Women with large breasts who need a mastectomy for breast cancer are often presented with very limited options for breast reconstruction: either a tissue expander or a flap procedure.

We developed SWIM breast-reconstruction technique specially for large-breasted women who want natural-looking breasts yet do not want an implant and / or a breast flap (with extensive incisions and recovery time it entails).

SWIM - The Technique

SWIM combines a nipple-sparing mastectomy with a breast reduction for a no-implant, no-free-flap breast reconstruction. SWIM is a complete nipple-sparing mastectomy with breast reconstruction. All breast mammary tissue is carefully removed in the mastectomy portion of the procedure. During the reconstruction portion of the procedure, no muscle is sacrificed or cut, no abdominal, back, or buttock tissue is transferred. The extra remaining skin and fat of the original breast is folded to create a smaller, reduced breast.

It uses the same type of anchor incisions as in a breast reduction.

The SWIM (Skin-sparing Wise-pattern Internal Mammary Perforator) preserves the blood flow to the nipple and employs the excess subcutaneous fat traditionally discarded in mastectomy to recreate a breast- all without an implant.

Who is a Candidate?

This procedure can be used on patients with moderate to large breasts and is an excellent option for women who have had radiation, those with large or pendulous breasts, those with medical problems, and those who have been told by their doctors that they are "not good candidates" for reconstruction.

How Long is the Recovery?

The recovery for a SWIM breast reconstruction with a mastectomy is 1-2 weeks, similar to that of a mastectomy alone.


The resulting breast size ranges from a large "A" to a small "C" (depending on the amount of subcutaneous fat and skin the patient has).

For patients who want a large breast than the existing fat allows, a second outpatient fat grafting surgery can be performed six months after the SWIM flap. During this procedure, fat is removed from other areas (typically the "love handles" or thighs and transferred to the breast).


SWIM FLAP Breast Reconstruction Before & After

LEFT: A 67 year old with a prior left breast lumpectomy and radiation. RIGHT: Four months after SWIM Flap.

See More Before & Afters

This 67-year old patient had a bi-lateral, nipple-sparing SWIM breast reconstruction. The photo on the right was taken 4 months after the procedure.

Sherie's Story: At age 57, Sherie (not her actual name) was diagnosed with breast cancer and had a lumpectomy and radiation. Eleven years later, cancer reoccurred in her left breast. She decided to have a bilateral mastectomy but was told by her prior surgeon that she was not a good candidate for tissue expander and implant reconstruction (due to her prior radiation) and that she couldn't have a nipple-sparing mastectomy because her nipples were too low. He recommended an extensive abdominal flab reconstruction.

She did not want to endure an eight to ten-hour abdominal flap surgery, so she elected to have a nipple-sparing SWIM flap; and is thrilled with her results.

The History of the SWIM Flap

In 2012, breast surgeon Dr. Heather Richardson surmised that the extra skin and subcutaneous fat that women with large breasts have could actually be an asset in breast reconstruction. In 2012, she developed a reconstruction that used some of the extra skin and fat to recreate the breast.

When she joined Bedford Breast Center, Dr. Cassileth and Dr. Richardson worked together to expand on this surgical technique. They perfected the use of nipple-sparing mastectomy along with a new type of plastic surgery reconstruction based on Dr. Richardson's original concept - creating the SWIM flap procedure.

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