SWIM mastectomy is a reconstructive surgery technique that does NOT require any breast implants or free flaps. This innovative and low-risk breast reconstruction technique, which stands for skin-sparing, Wise pattern, internal mammary perforator, was developed by Beverly Hills board-certified plastic and reconstructive surgeon, Dr. Lisa Cassileth, and oncological breast surgeon, Dr. Heather Richardson.1
This natural breast reconstruction procedure was first developed as the Goldilocks mastectomy, a technique originally invented by Dr. Heather Richardson, our colleague at the Bedford Breast Center. Historically, patients had two options—amputation or complex reconstruction. “Goldilocks” refers to a third option, offering a middle ground between the two extremes for certain patients who meet the physical requirements for an optimal outcome.
Goldilocks is a mastectomy with a skin closure that preserves local subcutaneous fat, and the result appears to be more like a small breast, with no nipple present. This allows for a more aesthetic closure for simple mastectomy. Dr. Richardson and Beverly Hills plastic surgeon Dr. Cassileth then advanced the technique to allow for the nipple and areola to be preserved using the Wise pattern incision—also known as the anchor incision often used in breast lift procedures—and to further recruit local fat into the area. This led to our current natural appearing SWIM Flap breast reconstruction, which looks more like a small-sized breast reduction, although in fact, it is a complete nipple-sparing mastectomy.
At Cassileth Plastic Surgery, we understand that every individual's breast reconstruction journey is unique, and we strive to provide a range of options to meet your specific needs. In addition to our renowned SWIM Flap Breast Reconstruction and Goldilocks procedures, we offer a specialized technique known as Aesthetic Flat Closure. This procedure focuses on creating a smooth chest appearance after mastectomy, without the need for additional surgeries, implants, or a second surgical donor site.
Aesthetic flat closure, often referred to as "going flat," involves a careful rearrangement of tissues to restore a natural contour to the chest. When mastectomy is performed without reconstructive procedures, the chest can sometimes appear concave, causing distress and affecting self-confidence. Our skilled surgeons utilize their expertise in tissue rearrangement techniques to address this concern and provide patients with an aesthetically pleasing flat chest appearance.
While Aesthetic Flat Closure differs from our SWIM and Goldilocks procedures, we recognize that individuals seeking an aesthetic flat result may also be interested in exploring these options. Like Aesthetic Flat Closure, both SWIM and Goldilocks procedures offer the advantage of not requiring additional surgeries or implants. Additionally, these techniques eliminate the need for a second surgical donor site, which is typically necessary in flap reconstruction methods.
The SWIM flap breast reconstruction is a type of autologous reconstruction that uses tissue from the patient's own leftover breast skin and fat to create a new breast mound. Some benefits of SWIM flap breast reconstruction may include:
Patients who have larger breasts or have extra skin are better candidates for SWIM reconstruction than small-breasted patients. Patients who want to avoid implant reconstruction or the multiple incisions required for flap reconstruction, such as a DIEP flap or TRAM flap, may prefer the result of a SWIM flap than from a traditional mastectomy. Any patient who has been told they are not a good candidate for breast reconstruction because of health issues, weight, or radiation injury may be a great candidate for a SWIM flap since it does not involve the risks of traditional reconstruction options and has a similar risk level to a simple mastectomy.2
Women with large breast sizes who need a mastectomy for breast cancer are often presented limited breast reconstruction options: either a tissue expander or a perforator flap procedure. We developed SWIM breast-reconstruction specifically for large-breasted women who want natural-looking breasts after mastectomy, yet do not want an implant or a breast flap or the extensive incisions, recovery time, or multiple procedures that those surgeries may entail.
Preparing for breast reconstruction typically involves a number of steps, including stopping smoking, maintaining a healthy diet and exercise regimen, and avoiding certain medications and supplements that can increase the risk of bleeding or other complications during surgery. You may also be advised to undergo a breast MRI or other imaging tests to help determine the best approach for your SWIM flap reconstruction.
It's also important to prepare mentally and emotionally for SWIM flap breast reconstruction, as it can be a significant step in the breast cancer journey. Support from loved ones, as well as counseling or support groups, can be helpful in coping with the physical and emotional changes that come with breast reconstruction.
The SWIM flap breast reconstruction surgery takes place in two stages of a single procedure. First, all breast tissue is carefully removed during the mastectomy portion of the procedure. All skin and subcutaneous fat are preserved. During the second, reconstruction portion of the procedure, the preserved skin and fat are folded in stacks to create the appearance of a new breast. No muscle is sacrificed or cut from donor sites, and 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 appearance of the breast. If extra skin is present lateral to the breast, often called the “dog ear”, this fat is also used under the breast and the extra skin is removed. The final result is a breast that appears smaller than the original, with scars similar to a breast reduction.
Browse our gallery of plastic surgery results to see the real life difference our work has made on patients just like you, who came to us for help and care.
Dr. Kelly Killeen is not just an outstanding surgeon and artist, she is also an angel. I had 15+ surgeries to correct an ongoing problem for last 10 years, numerous super-famous doctors worked on me, in different parts of the world, including Geneva, Berlin, etc.. So by the time I got into Dr. Kelly's hands the words "total mess" don't even begin to describe the actual condition of what used to be my breasts. Dr. Killeen, just as regular angel performed a miracle and made everything good again. I love you. There is also nurse Dee who is just incredible human being, here level of compassion, love and care is truly rare. Last but not the list there is a Brit called Jade - she is so beautiful, funny and totally awesome, I will find a reason to come again for some facial peeling or something else simple just to see you guys! I am so blessed to have met these beautiful people, they maybe just part of exceptional medical team, but in my heart they will always be my friends...
Recovery after SWIM flap breast reconstruction can vary depending on several factors including the individual patient's health and healing process. In general, patients should expect some discomfort, swelling, and bruising in the days and weeks following surgery. Pain medication and compression garments may be prescribed to help manage these symptoms.
It's important to follow Dr. Cassileth’s post-operative instructions carefully, which may include avoiding strenuous activity, lifting heavy objects, or driving for several weeks. You may also be advised to wear a special support bra or garment during the recovery period to help minimize swelling and support the healing tissues.
Follow-up appointments with Dr. Cassileth will allow her to monitor your healing process and address any concerns or complications that may arise. Overall, recovery from SWIM flap breast reconstruction can take several weeks to several months, depending on the extent of the surgery and your individual healing process. With proper care and attention, however, most patients are able to return to their normal activities and enjoy the benefits of restored breast symmetry and appearance.
If you are considering breast reconstruction and would like to learn more about the SWIM flap procedure, please contact us to schedule a consultation. During your appointment, Dr. Cassileth will evaluate your medical history and body type to determine if you are a good candidate for this procedure, and discuss the benefits and risks of the surgery in detail. We look forward to helping you explore your options and achieve your desired breast reconstruction results.
Good candidates for SWIM flap reconstruction need a sufficient amount of breast skin, fat, and blood vessels available to create the new breast mound. That’s because the tissue for SWIM flap reconstruction is taken from the leftover breast skin and tissue after the mastectomy portion of this two-step procedure is complete.
The surgery can take several hours, depending on the extent of the reconstruction needed, preservation of the nipple, and the amount of excess skin and fat being used to recreate the breasts.
Recovery can vary, however, we typically recommend patients spend a couple of days in an aftercare facility under the guidance of a nurse. Following that, most patients are able to then comfortably spend the rest of their recovery period at home, which is several weeks of rest and limited activity to allow the new tissue to heal. Most patients can resume light exercise after two weeks but should refrain from heavy lifting for six weeks. It is recommended that patients traveling from out of town should plan to stay in Los Angeles for 10 days after their surgery.
As with any surgery, there are risks and potential complications, such as infection or problems with wound healing. Dr. Cassileth will discuss these risks with you prior to your procedure.
SWIM flap reconstruction uses the patient's own tissue, while implant-based reconstruction uses breast implants. Both have benefits, and the choice will depend on factors such as the patient's medical history, body type, and personal preferences. Dr. Cassileth can help you decide which option is best for you.
1Cassileth LB, Killeen, KL, Richardson HH. SWIM Flap: Skin-Sparing, Wise Pattern, Internal Mammary Perforator Breast Reconstruction. JACS. January 17, 2020; 230(5). DOI:https://doi.org/10.1016/j.jamcollsurg.2019.12.015
2Wilkins EG, Hamill JB, Kim HM, et al. Complications in Postmastectomy Breast Reconstruction: One-year Outcomes of the Mastectomy Reconstruction Outcomes Consortium (MROC) Study. Ann Surg. 2018;267(1):164-170. doi:10.1097/SLA.0000000000002033
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