Having a mastectomy for breast cancer can bring up questions about how your body may change and whether breast reconstruction is right for you.

If you want a natural-looking breast shape or are concerned about scarring or the shape of your chest after breast cancer surgery, you have options. Two approaches that may help are Goldilocks mastectomy and skin-sparing wise-pattern internal mammary perforator (SWIM) breast reconstruction.

Here’s more about the Goldilocks procedure and SWIM surgery that you can discuss in detail with your surgeon. Like other breast reconstruction options, these types of surgeries are typically done by a breast surgeon or surgical oncologist, sometimes with the help of a plastic surgeon.

What Are Goldilocks Mastectomy and SWIM Surgery?

Goldilocks mastectomy and SWIM surgery are surgical approaches that combine mastectomy with breast shaping or reconstruction without implants in a single procedure.

A Goldilocks closure after mastectomy may also be an option if you choose not to have breast reconstruction but don’t want a completely flat chest.

Along with Goldilocks mastectomy, SWIM surgery is another nonimplant reconstructive procedure after mastectomy. This type of surgery has become more popular in recent years.

Goldilocks mastectomy and SWIM surgery are less complicated than some other types of breast reconstruction and may have a shorter recovery time. They may also appeal to people who want more natural-looking results.

In a Goldilocks mastectomy, cancerous breast tissue is first removed. In the same surgery, the remaining noncancerous fatty tissue and skin from the breast are used to reshape and form a small breast. Healthy tissue used for reconstruction of the breast may be taken from under the breast or the side of the chest.

Goldilocks and SWIM surgery are shorter and less invasive procedures than some other types of breast reconstruction. In SWIM surgery, the nipple can be preserved during the procedure. Sometimes, SWIM surgery is also called a nipple-sparing Goldilocks mastectomy.

If the nipple can’t be saved, there are options for recreating a nipple through nipple reconstruction — in a later surgery — or 3D nipple tattoo after the Goldilocks surgery has healed.

Goldilocks surgery may also be appropriate for those who don’t choose to have breast reconstruction and want a smooth contour with a small breast mound instead of a flat chest. After a mastectomy, the chest can sometimes look sunken or curved inward.

The Goldilocks procedure uses skin and fatty tissue to create a smoother chest shape for those who choose not to have breast reconstruction but also don’t want to remain flat or have what’s known as an aesthetic flat closure, a smooth, flat chest after mastectomy.

How Do Goldilocks Mastectomy and SWIM Surgery Compare to Other Types of Reconstruction?

For those who want a reconstructed breast, the SWIM surgery and Goldilocks procedure are considered good middle-ground options. It’s not too much, and it’s not too little — just like in the children’s story, “Goldilocks and the Three Bears” — which is how it got its name.

For example, in flap reconstruction, the new breast is formed with fatty tissue that is taken from another area of the body, such as the back or abdomen. This type of surgery requires multiple incisions and recovery for both the breast area and the area of the body from which tissue was taken for the breast reconstruction.

With implant reconstruction, more than one surgery is often needed, especially if tissue expanders are used. There’s also the risk of a breast implant rupturing. Breast implants also need to be replaced after 10 or 15 years.

Who Is a Good Candidate for a Goldilocks Procedure or SWIM Surgery?

SWIM surgery and the Goldilocks procedure may be good options if you have larger breasts and enough extra fat and skin to form a small breast mound. Those with breast drooping, known as ptosis, may be good candidates because they often have the extra skin and tissue needed for the surgery.

It’s important to know that with a Goldilocks mastectomy, the new breast will be much smaller than the original breast. This can cause breasts to be uneven if you’re having surgery on just one breast. A Goldilocks mastectomy or a SWIM procedure can be the right choice if you’re having a double mastectomy. This way, you’ll avoid having uneven breasts.

Goldilocks surgery also may be a good option for those with large breasts who want to combine mastectomy with contralateral breast reduction or breast lift surgery. This can result in evenly sized breasts, where you have a choice in the contouring and size of your breasts.

“My surgeons introduced me to Goldilocks reconstruction that would be done simultaneously with the mastectomies,” a MyBCTeam member shared. “I was a 36DDD, and I’m now a 34A/AA (my request for an A cup).”

Another member said, “I am very happy with my Goldilocks look, even though I had a period of silent emotional back and forth, accepting that I went from a 36DD to an A cup. I think I will go braless and look for some camisoles to wear under my shirts for work.”

SWIM breast reconstruction may not be appropriate for breast cancer that’s in the lower part of the breast or very close to the skin. This surgery may not be a good fit if you have a health condition that makes it harder for your body to heal.

If you have a lot of scarring on the breast, the skin may not have enough blood flow for a Goldilocks mastectomy or SWIM surgery. Good blood flow is especially important for SWIM surgery because the nipple is kept in place and needs enough blood supply to stay healthy.

Limitations of Goldilocks Mastectomy and SWIM Surgery

There are some limitations to a SWIM surgery and a Goldilocks mastectomy. If you’re considering one of these procedures, talk to your surgeon about the limitations.

One limitation is that the results can be hard to predict. Your surgeon may not know how much fatty tissue is available for a Goldilocks reconstruction until the surgery begins. This can be true even if you have larger breasts.

If there’s less fatty tissue than expected, the breast reconstruction may result in a smaller breast than desired. Even though this surgical procedure can technically be done in one session, with Goldilocks or SWIM surgery, you may need another procedure to get the results you want.

Goldilocks mastectomy and SWIM surgery are newer breast reconstruction options. Because of this, researchers are still studying their long-term results. More research is needed to understand the possible benefits and risks of these surgeries over time.

Recovery From Goldilocks Mastectomy and SWIM Surgery

Recovery time for a Goldilocks procedure or a SWIM surgery is generally faster than other types of breast reconstruction that are more complicated. Most people can drive and return to work within two weeks of these procedures. Most people can return to their usual activities about one month after surgery.

Your doctor will give you detailed care instructions for your recovery to help with proper wound healing. It’s important to follow all instructions carefully and not lift anything heavy or participate in certain types of activity before your doctor says you’re ready.

You may also have a surgical drain to remove fluid that can build up after a mastectomy. Your healthcare team will show you how to manage the drain, which you may need for a couple of weeks after surgery. Your doctor will also advise you on how to manage pain.

It’s essential to attend all follow-up doctor appointments after any mastectomy to monitor your recovery. Talk to your healthcare team about potential complications, such as signs of infection.

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On MyBCTeam, people share their experiences with breast cancer, get advice, and find support from others who understand.

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