SWIM Breast Reconstruction
No Implant SWIM Breast Reconstruction in Beverly Hills
SWIM Breast Reconstruction
No Implant SWIM Breast Reconstruction in Beverly Hills
SWIM Flap Breast Reconstruction is a groundbreaking procedure that redefines implant-free breast reconstruction. Developed by leading board-certified Beverly Hills plastic surgeon, Dr. Lisa Cassileth, and renowned oncological breast surgeon, Dr. Heather Richardson (of Bedford Breast Center), this advanced technique uses the patient’s own tissue—without the need for implants or free flaps—to naturally rebuild the breast. Combining innovation with safety, SWIM (Skin-Sparing, Wise Pattern, Internal Mammary Perforator) offers a highly effective, low-risk solution for those seeking a more natural approach to breast reconstruction.
SWIM Breast Reconstruction Topics On This Page
Implant
Breast Reconstruction
- History of SWIM Flap Breast Reconstruction
- Aesthetic Flat Closure
- Benefits of SWIM Flap Breast Reconstruction
- Who Is A Candidate For SWIM Flap Breast Reconstruction?
- Preparing For SWIM Flap Breast Reconstruction
- The SWIM Flap Breast Reconstruction Procedure
- Recovery After SWIM Flap Breast Reconstruction
- SWIM Flap Before & After Photos
- FAQs About SWIM Flap Breast Reconstruction
Dr. Cassileth and her staff were outstanding! I had a double mastectomy with a SWIM reconstruction and I am very happy with the results. Dr. Cassileth and her staff were very professional and truly amazing at their craft. I always felt cared for during every step of the process. I only wish that every woman could have such wonderful care when having to face a mastectomy due to cancer. - Kristi K. via Google My Business
History Of SWIM Breast Reconstruction Technique
This natural breast reconstruction procedure was based on the Goldilocks mastectomy, a technique originally invented by Dr. Heather Richardson, a 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 patients who meet the physical requirements for an optimal outcome.
Goldilocks is a mastectomy with a skin closure that preserves local subcutaneous fat; the result appears 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 preserve the nipple and areola 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 SWIM Flap breast reconstruction, which looks more like a small-sized breast reduction, although in fact, it is a complete nipple-sparing mastectomy.
Aesthetic Flat Closure
At Cassileth Plastic Surgery, Dr. Cassileth understands that every individual’s breast reconstruction journey is unique, and strives to provide a range of options to meet your specific needs. In addition to the groundbreaking SWIM Flap Breast Reconstruction and Goldilocks procedures, Dr. Cassileth offers 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 appear concave, causing distress and affecting self-confidence. Dr. Cassileth utilizes her 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 SWIM and Goldilocks procedures, Dr. Cassileth recognizes 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.
Benefits Of SWIM Flap Breast Reconstruction
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 include:
- Natural appearance: Because the tissue used in the reconstruction is from the patient’s own body, the resulting breast mound can have a more natural look and feel compared to breast reconstruction with implants.
- Nipple-sparing: The nipple and areola are preserved, leading to a more natural-looking breast.
- Long-lasting results: Unlike implants, which may need to be replaced over time, the tissue used in SWIM flap reconstruction is permanent and should not require additional surgeries in the future.
- Improved symmetry: Because Dr. Cassileth can sculpt the tissue to match the patient’s remaining breast, SWIM flap reconstruction can result in improved symmetry and a more balanced appearance.
- Lower risk of complications: Since the tissue used in SWIM flap reconstruction is from the patient’s own body, there is a lower risk of complications such as infection or rejection compared to implants.
- Improved quality of life: Breast reconstruction, including SWIM flap reconstruction, can help restore a woman’s self-confidence and body image following a mastectomy, leading to improved quality of life.
Who Is A Candidate For SWIM Flap Breast Reconstruction?
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 with limited breast reconstruction options: either a tissue expander or a perforator flap procedure. Dr. Cassileth 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 SWIM Flap Breast Reconstruction
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 Procedure
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.
Recovery After SWIM Flap Breast Reconstruction
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.
Patient Results
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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 approximately four 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, Dr. Cassileth typically recommends 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. The majority 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.
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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.
1 Cassileth 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
2 Wilkins 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