Case #1204
SWIM Flap Reconstruction
63-year-old female with large breasts and BRCA mutation. She elected to undergo prophylactic mastectomy but was not interested in implant-based or free flap reconstruction. At the time of her mastectomy, Dr. Azadgoli reconstructed small breasts using her remaining tissue (SWIM fl
63-year-old female with large breasts and BRCA mutation. She elected to undergo prophylactic mastectomy but was not interested in implant-based or free flap reconstruction. At the time of her mastectomy, Dr. Azadgoli reconstructed small breasts using her remaining tissue (SWIM flaps).
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Why this approach
The decisions that shaped this surgical plan.
- Reconstruction planned around the oncologic mastectomy — surgical timing, tissue preservation, and incision pattern were chosen to support both safe cancer clearance and long-term aesthetic outcome.
- Goldilocks technique reflects what the oncologic team and surgical plan determined was safe; it sets up a cleaner reconstructive result.
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.
- No overhead clothing for 3 weeks. Stock front-zip tops, supportive sports bras (post-clearance), and the drain pouches we provide.
- Day-of transport and an overnight companion (24 hours minimum) are required for discharge.
- 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
First week prioritizes drain care, walking short distances, and avoiding any overhead reaching. Multi-modal pain control keeps narcotic use brief.
- Week 2
Drains typically come out toward the end of the week. Suture lines are inspected; lymphatic drainage begins once approved.
- Week 4
Activity ramps slower than average. PT check-in at week 4 anchors the next phase.
- Week 6
Most physical restrictions lift. Return to strength training, full-impact cardio, and overhead lifting.
- 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.
Continued care
Recommended aftercare, skincare, and MedSpa services for SWIM Flap Reconstruction.
- Coordination
Long-term surveillance imaging stays on the oncology pathway; our team coordinates timing with theirs.
Post-mastectomy patients stay on a long-term surveillance pathway.
- Aftercare
Early lymphatic massage protocol initiated in the first week of recovery.
Lymphatic disruption from axillary work makes early drainage more valuable.
- Coordination
BRCA pathway includes genetic counseling check-in for family planning and surveillance.
BRCA+ patients benefit from coordinated long-term risk planning.
- Aftercare
Activity progression coordinated with PT — formal check-in scheduled for week 4.
Older patients benefit from a guided return-to-activity plan.
- MedSpa
Tissue-tightening protocol (fractional laser) postponed until month 6 on the reconstructed side.
Reconstructed tissue softens more slowly than primary breast surgery.
