Case #1389 · Tampa, Fl
SWIM Flap Reconstruction
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This 43-year-old patient from Tampa, Fl carries the BRCA1 gene and decided to undergo a preventative bilateral mastectomy with implant-free breast reconstruction. Dr. Cassileth performed SWIM Flap Breast Reconstruction using the patient's native skin and tissue to create a natura
Continued care
Recommended aftercare, skincare, and MedSpa services for SWIM Flap Reconstruction.
- Lymphatic drainage massage starting week 2
- Compression garment for 6–8 weeks
- Scar management protocol
- Gentle range-of-motion exercises
- Hyperbaric Oxygen Therapy to support healing when recommended
- SkinCeuticals Advanced Scar Control
- Medical-grade silicone sheeting
- SPF 50+ sun protection
- LED light therapy for healing
- Laser or microneedling for scar refinement after 3 months
- Aftercare
Extended hyperbaric oxygen course (10–15 sessions) to support bilateral healing.
Bilateral procedures heal more reliably with sustained HBOT.
- Coordination
BRCA pathway includes genetic counseling check-in for family planning and surveillance.
BRCA+ patients benefit from coordinated long-term risk planning.
Why this approach
The decisions that shaped this surgical plan.
- Bilateral swim performed in one operative session so symmetry, tissue handling, and final shape track between both sides.
Pre-op preparation
What to do before surgery. Specific to this case.
- Aspirin, ibuprofen, vitamin E, and fish oil discontinued 14 days pre-op to reduce bruising risk. Acetaminophen is allowed.
- Nicotine in any form, cigarettes, vapes, patches, gum, paused six weeks before and six weeks after surgery. Nicotine narrows blood vessels and slows wound 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
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
Tissue softens, scars begin to fade, and overall shape settles toward final. Scar maturation continues for another 6 months.
“With SWIM reconstruction, we use the patient's own healthy tissue to create a natural, implant-free breast. For many women, knowing their result is entirely their own body is deeply meaningful.”
Dr. Lisa Cassileth
