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 in conjunction with 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. The Goldilocks mastectomy 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 to be preserved, and to further recruit local fat into the area. This led to our current natural appearing breast reconstruction, which looks more like a small sized breast reduction, although in fact it is a complete nipple-sparing mastectomy.
The breast reconstruction surgery takes place at one procedure, in two stages. First, all breast tissue is carefully removed in the mastectomy portion of the procedure. All skin and subcutaneous fat is preserved. During the second, reconstruction portion of the procedure, the extra fat is folded in stacks to create the appearance of a new breast. No muscle is sacrificed or cut from donor sites, 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 a 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.
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*Individual results may vary
Patients who have larger breasts or have extra skin are better candidates for SWIM reconstruction than small breasted patients. Any patient that wants to avoid implant reconstruction or flap reconstruction, such as DIEP flap or TRAM flap, may have a more pleasing aesthetic result from 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 also be great candidates 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 size who need a mastectomy for breast cancer are often presented with very limited options for breast reconstruction: either a tissue expander or a perforator flap procedure. We developed SWIM breast-reconstruction technique specially 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.
Dr. Cassileth is an amazing surgeon. She is incredibly talented and a lovely human being. She really cares for her patients and it shows. Did I say she is also very, very talented? I came to her for a revision of breast reconstruction after having had a not-sogood job with my breast reconstruction surgery following a double mastectomy. She did magic. My results now look outstanding! I look incredibly natural! Going through a mastectomy-breast reconstruction is an incredibly hard experience as it is, and I believe we women deserve a plastic surgeon who can understand us and make us feel beautiful. Dr. Cassileth did just that! Also, her office is beautiful and all the staff was pleasant, professional and caring. All and all, 5 stars! I would give it 6 stars if I could.
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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