Case #1388 · Los Angeles, CA
SWIM Flap Reconstruction
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This 67-year-old patient from Los Angeles, CA was diagnosed with breast cancer. She underwent a bilateral nipple-sparing mastectomy. Dr. Cassileth performed SWIM breast reconstruction as a second procedure This revolutionary implant-free breast reconstruction procedure pioneered
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
Hyperbaric oxygen series extended to 10–15 sessions for bilateral tissue support.
Bilateral procedures heal more reliably with sustained HBOT.
- Coordination
Imaging cadence reviewed against the oncology plan at the 3-month visit.
Post-mastectomy patients stay on a long-term surveillance pathway.
- Aftercare
Lymphatic drainage prioritized at week 1 to limit post-axillary swelling.
Lymphatic disruption from axillary work makes early drainage more valuable.
- Aftercare
Mobility ramp slowed; physical therapy consultation at week 4.
Older patients benefit from a guided return-to-activity plan.
Why this approach
The decisions that shaped this surgical plan.
- Oncology and reconstruction planned together rather than in sequence, the mastectomy pattern was selected to leave the best possible foundation for the reconstructive technique that followed.
- 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.
- Stop NSAIDs, aspirin, and high-dose fish oil two weeks before surgery; the surgical team provides a full medication list at the pre-op visit.
- No nicotine for 6 weeks before through 6 weeks after surgery. The vascular impact directly affects skin healing.
- Front-closing clothing only for 3 weeks. Drain holders and supportive surgical bras are issued at discharge.
- A driver is required the day of surgery and a responsible adult should stay with you the first 24 hours.
- Surgical date confirmed against oncology pathway. Imaging and pathology results are reconciled by the team at the pre-op visit.
- Medical clearance and a current EKG are obtained pre-op. Anesthesia review confirms any chronic-condition adjustments.
Recovery timeline
Milestones specific to this case. Individual recovery varies.
- Day 1–7
Drain care, low-lift movement, and rest through the first week. Nerve blocks (Exparel) cover the worst of the pain through day 3.
- Week 2
Patients off prescription pain medication, walking 1–2 miles daily, and back to most light household activity.
- Week 4
Older patients benefit from a guided plan here, PT consult, gradual activity, and stretch goals through week 8.
- Week 6
Standard clearance milestone. Patients return to most exercise, gym work, and sleeping in any position.
- Month 3
Oncology follow-up timed with the surgical check. Tissue settled enough to assess reconstruction symmetry.
- Month 6
Reconstruction or combo result reaches its mature appearance. Any planned refinement step is timed for this window.
“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
