Comparing Reconstruction Options After Mastectomy Surgery

Mastectomy is often the best and most effective method of treating breast cancer. However, many women don’t realize they have options for breast reconstruction after mastectomy, several of which have been developed quite recently. By knowing the most current choices, you and your surgeon can design the best reconstruction plan for your individual needs and goals.  

The doctors at Bedford Breast Center in Beverly Hills, California, are innovators in breast cancer surgery. They understand the importance of feeling whole again after a mastectomy and consider breast reconstruction an important part of the healing process.  

Choices Begin Before Your Mastectomy

Many women are unaware of the improved options for mastectomy surgery and breast reconstruction that have been developed over the past ten years. By arming yourself with the latest information, you can take charge of your body and your health, even in the wake of a breast cancer diagnosis

Traditional Mastectomy Surgery

Traditionally, mastectomy and reconstruction required two separate procedures scheduled several months apart. During mastectomy surgery, devices called tissue expanders were placed in the chest cavity to stretch the muscles in the chest, creating space for the placement of breast implants later. 

During the months following mastectomy surgery, patients periodically returned to their doctor to have the expanders incrementally filled with saline to stretch the chest muscles gradually. Once the expanders sufficiently stretched the muscles, reconstruction surgery to place the implants was then performed. 

Because of the amount of time that elapsed between mastectomy and reconstruction, nipple-sparing was not an option. Further, because nerves were severed during mastectomy surgery and not repaired, women often experienced permanent, disconcerting numbness in the chest. These lingering reminders of the cancer often made it more difficult for women to move forward, even after treatment was over. 

New and Better Options Are Now Available

Women who require a mastectomy but have not yet undergone the procedure have more reconstruction options today. For this reason, it’s essential to meet with an experienced breast reconstruction specialist before scheduling your mastectomy to discuss and consider all your options.

New techniques have been developed that eliminate the need for tissue expanders and multiple surgeries. Certain procedures spare the nipple for a more natural look, and some surgeons can repair the nerves severed during mastectomy surgery to restore sensation for eligible patients. 

Your breast reconstruction options may include: 

  • Direct-to-implant reconstruction
  • Goldilocks mastectomy
  • SWIM mastectomy

Direct-to-implant reconstruction and the SWIM mastectomy are both nipple-sparing procedures. To learn more about breast reconstruction surgery after mastectomy, please visit

What is Direct-to-Implant Reconstruction?

Fast becoming the standard of care in breast reconstruction, the groundbreaking direct-to-implant reconstruction procedure, also known as direct-to-implant reconstruction, was pioneered by Bedford Breast Center surgeon Dr. Lisa Cassileth.

Direct-to-implant reconstruction makes it possible for the mastectomy and reconstruction to be performed as two parts of one surgical procedure—resulting in some of the best possible outcomes in breast reconstruction today. 

Two surgical specialists perform specific parts of the direct-to-implant reconstruction procedure. First, the general surgeon removes the breast tissue through a small incision, thus minimizing scarring. The plastic surgeon then inserts the implant and creates an internal bra using a unique collagen substance. The result is a beautiful, natural breast that looks good almost immediately following surgery.

Unlike traditional mastectomies, the patient awakens from surgery with breasts and scarring so minimal that they can confidently wear swimsuits and low-cut clothing. Immediate breast reconstruction avoids many of the painful psychological effects of traditional mastectomy and reconstruction techniques.

In some cases, patients will also undergo fat grafting breast reconstruction, which uses the patient’s own fat taken from other areas of the body to enhance the breast shape, after the initial direct-to-implant reconstruction surgery.

Direct-to-implant reconstruction is now the standard of care in the U.S. Still, rare circumstances, such as some instances of inflammatory breast cancer, may prevent a patient from being a candidate for direct-to-implant reconstruction. Our surgeons look at every aspect of your case to determine the best reconstruction approach for your health and your appearance.

What is the Goldilocks Mastectomy?

Bedford Breast Center’s Dr. Heather Richardson developed the Goldilocks mastectomy for patients who don’t want implants and do not want to “go flat,” which means living without any breast mound at all.

The Goldilocks mastectomy removes any cancerous tissue and, in a technique similar to breast reduction, skillfully forms a smaller breast using the residual healthy tissue and skin. 

The Goldilocks procedure doesn’t require tissue expanders or surgical tissue transfer, unlike a traditional mastectomy. This technique doesn’t use implants and leaves the patient with smaller breasts—a benefit for patients with very large or sagging breasts. 

Advantages of the Goldilocks mastectomy:

  • No implants or artificial devices 
  • No additional surgeries are required
  • Can be performed on one or both breasts
  • Suitable for prophylactic mastectomy 
  • Shorter recovery time and less pain compared to traditional breast reconstruction

Since the breast gland is removed, screening mammograms will no longer be required. And, depending on the patient’s cancer status, most women don’t need radiation following a Goldilocks mastectomy. 

What is the SWIM Mastectomy?

The acronym “SWIM” stands for skin-sparing, wise pattern, internal mammary perforator. Bedford’s Dr. Cassileth and Dr. Richardson created SWIM mastectomy, a refinement of the Goldilocks Mastectomy, which allows the nipple to be preserved and creates a more substantial breast size and shape. 

Advantages of the SWIM technique:

  • Can be performed on one or both breasts
  • Suitable for prophylactic mastectomy 
  • No further surgeries are required
  • No implants or artificial devices
  • Ideal for patients with very large or sagging breasts 
  • Sparing the nipple allows for a more natural result

Like the Goldilocks mastectomy, the SWIM technique’s surgical removal of the breast gland means screening mammograms will no longer be required. Most patients don’t need radiation following a SWIM mastectomy either. 

In the past, large-breasted women had few suitable options for breast reconstruction. The SWIM technique was developed to provide these patients with natural-looking breasts following mastectomy surgery. 

At our Beverly Hills medical center, we perform the SWIM breast reconstruction surgery as one procedure in two stages. First, breast tissue is removed during the mastectomy stage while subcutaneous fat and skin are preserved. Second, during the reconstruction stage, the extra fat is folded in stacks to create the appearance of a new breast. The result is a smaller breast with scars similar to a breast reduction procedure.

Your Options in Nipple-Sparing and Sensation-Preserving Mastectomies

Nipple loss and breast numbness are lasting effects of mastectomy surgery that patients may not consider before undergoing the procedure. Bedford Breast Center of Beverly Hill is one of the only California medical centers to offer nerve grafting at the time of mastectomy surgery, giving patients a sensation-preserving solution. 

Innovative techniques like nipple-sparing and sensation-preserving mastectomy allow women to look and feel more like themselves following breast cancer surgery.

Going Flat

For some patients, “going flat” with an aesthetic flat closure is the best choice after a mastectomy. There is no implant required, you only have to undergo a single surgical procedure, and there is no additional surgical donor site required to reconstruct your breast(s).

The advantage of the aesthetic flat closure to “go flat” is that the tissue in the chest is rearranged to create a flat appearance instead of a concave, sunken effect that can occur in non-aesthetic closures. The result is a smooth, flat chest appearance.

Our Medical Center’s Mastectomy and Breast Reconstruction Options to Fit Your Needs

During the past decade, cancer surgery has progressed at an unprecedented rate. Bedford Breast Center provides our patients with world-class treatment and guidance during the diagnosis and treatment of breast cancer. We’re proud to have two of the country’s top breast cancer surgeons developing and performing the most innovative techniques with outcomes vastly superior to traditional methods.  

To help you understand and select the best breast reconstruction surgery options for you, schedule a consultation with one of our Los Angeles breast surgery specialists. Contact our Beverly Hills medical center or call us at (310) 278-8590.

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