The demand for safer, more natural reconstruction methods after mastectomy has led to the popularity of the Goldilocks mastectomy and SWIM breast reconstruction at Bedford Breast Center. Dr. Heather Richardson and Dr. Lisa Cassileth developed these techniques to offer a viable, natural alternative for those seeking cancer removal and breast reconstruction without implants or extensive flap procedures.
Implants in Breast Reconstruction
Implant-based methods are a common choice in breast reconstruction surgery. However, concerns about the safety and long-term implications of breast implants have led to increased caution, particularly among breast cancer patients. Implant reconstruction has traditionally involved the use of a tissue expander followed by inserting a breast implant. While this method restores breast shape and volume, significant concerns exist:
- Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL): This rare type of non-Hodgkin’s lymphoma has been linked to textured breast implants. While the incidence of BIA-ALCL is low, it’s understandably alarming for individuals already battling breast cancer and can create an added psychological burden for patients in recovery or remission from breast cancer.
- Breast Implant Illness (BII): This term refers to a range of systemic symptoms reported by patients, including symptoms such as fatigue, cognitive issues, joint and muscle pain, and immune system dysfunction. These symptoms are believed to be related to silicone leakage and biofilms on the surface of the implants. Although a direct causal link between implants and these symptoms is still a topic of ongoing research, the reported symptoms are real and distressing for the patients experiencing them.
Given these concerns, organizations such as BreastCancer.org and media outlets such as The New York Times have recognized “going flat”—opting for no reconstruction after mastectomy—as a viable and often preferable option for some patients. This decision can be driven by the desire to avoid the potential risks associated with implants and eliminate the need for future surgeries related to implant complications or replacements.
Traditional Breast Flap Reconstruction
Breast flap reconstruction techniques such as transverse rectus abdominis muscle flap (TRAM), deep inferior epigastric perforator flap (DIEP), and superficial inferior epigastric artery flap (SIEA), avoid breast implants or going flat after mastectomy. DIEP flap breast reconstruction, for example, repurposes tissues—which may include muscle—from another area of the patient’s body. While these techniques offer an alternative, they bring their own set of challenges.
These breast flap reconstruction surgeries are long and carry the risk that the transferred tissue may die. In our experience, few patients choose flap breast reconstruction because they don’t want to sacrifice a donor site or lose muscle strength.
The Psychological Impact of Going Flat
Some patients may experience feelings of loss after choosing not to have reconstruction. The absence of breast contour can be a significant psychological hurdle that negatively affects body image and self-esteem.
Pioneering a Better Option
For some women, the traditional reconstruction options simply weren’t acceptable. Many patients don’t want to worry about breast implant safety after going through cancer, nor do they want to face the potential complications of extensive flap reconstruction techniques. And in our experience, women don’t want the concave or deformed breasts that can result from going flat, so our innovative surgeons developed something better.
The Goldilocks Mastectomy
The Goldilocks mastectomy uses extra skin and tissues to create a breast mound as a second stage of mastectomy surgery. The procedure’s details vary according to the physical characteristics of the patient. However, regardless of body type, we create a new breast from excess tissues such as fat and skin, producing implant-free, flap-free, results.
SWIM Breast Reconstruction
SWIM reconstruction—which stands for skin-sparing, wise pattern, internal mammary perforator—combines oncological precision with plastic surgery artistry.
The SWIM Technique
The SWIM procedure allows surgeons to merge cancer removal with breast reshaping in one operation. In many ways, the technique mirrors a breast reduction more closely than a traditional mastectomy—achieving a smaller, more refined breast that can be ideal for larger-breasted women who want to maintain a natural shape post-surgery.
The SWIM Advantage
SWIM reconstruction sidesteps the risks associated with implants or traditional flap techniques while restoring a feeling of “wholeness.” By retaining the natural breast envelope, sparing the nipple, and using the patient’s own skin and fat, the SWIM technique supports a recovery that’s not just about a quicker return to routine but also moving forward with a restored sense of self.
Is SWIM Right for You?
Women with larger, sagging breasts, or those who aren’t eligible for traditional breast reconstruction due to weight, health issues, or radiation injury, may find SWIM a suitable and attractive option.
Learn more about Goldilocks mastectomy and SWIM reconstruction in this related blog post.
Schedule a Consultation
To explore your breast reconstruction options, call our office at (310) 278-8590 or request a consultation. Our skilled, compassionate team is here to guide you through every step of this journey.