Abstract
Here we present a novel method of breast reconstruction, a skin-sparing, wise pattern, internal mammary perforator (SWIM) flap. The nipple-sparing mastectomy is completed as per the oncological standard. Reconstruction is then performed, using only local flaps to create a breast. The nipple is carried on a medial flap that is based on the internal mammary perforators. A lateral intercostal artery perforator (LICAP) flap can also be utilized for additional volume. There is no implant or anastomosis required and no muscle is sacrificed. Incisions are closed based on a classic Wise pattern. Seven patients underwent bilateral SWIM flaps for a total of fourteen breasts, with minimal complications limited to minor wound healing and one case of operative fat necrosis. All patients were satisfied with their results, with two patients desiring larger breast size and undergoing fat grafting at a secondary surgery.
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