This plastic surgeon came up with an innovative reconstruction technique that allows breast cancer survivors to forgo implants without going flat—all within the same surgery as their mastectomy. 

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Lisa Cassileth
Credit: Courtesy of Cassileth

What made you want to be a doctor?

I’m a doctor’s daughter, but I was actually an architecture major in college and loved it. You take physics and biology as part of your architecture studies, and they clicked with me. 

And why specialize in plastic surgery?

With my architecture background, I was already a little more spatially trained. I understood how to rearrange things. With breast reconstruction—specifically, as a female—you’re more likely to see the patient as yourself. I’m not just creating hot boobs so a woman can be hot. I’m listening to patients and thinking, “How can I best fulfill what she wants for herself?” 

You created a technique that allows breast cancer survivors to skip implants and keep their nipples. What inspired you to create this technique?

The vast majority of women who have breast reconstruction have implants. To do that, you take that flat mastectomy scar, where the nipples have been removed, and put a tissue expander under there to expand the skin so you can get an implant in there. When I was working on these, there were some fantastic studies coming out showing that there was no benefit in removing the nipple or areola unless there was cancer in those areas. That meant all of a sudden you could have a small incision under your breast and have a total mastectomy. 

So you started to realize there could be other methods that could be explored?

There are women who want implants, and others who want to go flat. That’s their choice to make. I just wanted to provide another option for women who didn’t feel like those were the directions they wanted to go in. That’s how SWIM (Skin-sparing Wise-pattern Internal Mammary perforator) was developed. It combines a nipple-saving mastectomy, where all the breast tissue is removed, and the leftover skin and fat from the breast is used to create a new breast. 

Do you have any advice for women going through tough medical situations on how they can advocate for themselves?

I love a patient who comes in and has looked things up on the internet and has questions. A lot of doctors get offended if a patient has turned to Dr. Google, but I am like, “Bring it on.” It allows us to have a conversation and allows me to talk to the patient about why I do things the way I do them. One thing that disappoints me is when people are afraid to ask questions. If a doctor has a problem with you asking questions, they are not the right doctor for you. 

As of now, this technique is available at Dr. Cassileth’s Beverly Hills private practice (drcassileth.com), but the plan is to bring it to more women soon. 

This article originally appeared in the January/February 2021 issue of Health Magazine. Click here to subscribe today!

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