mong the variety of techniques used for breast reconstruction following skin-sparing mastectomy for patients with breast cancer, a few are ideal for patients at high risk of complications. [1][2][3] The original Goldilocks technique, as described by Richardson and Ma in 2012, sought to provide a safe and efficacious alternative for these patients. By folding and shaping mastectomy skin flaps into a breast mound without implants or tissue from other areas of the body, this technique avoids complications traditionally associated with prosthetic and autologous methods of reconstruction (Fig. 1). Although, compared with more complex methods, the Goldilocks technique offers less control of reconstructive shape and volume, for many patients, it is more desirable than no reconstruction, a safe alternative that for high-risk patients may be "just right." 4 As obesity rates top 15% globally and the incidence of yearly female breast Background: The Goldilocks technique seeks to provide a safe alternative for patients who are otherwise at risk of adverse complications during reconstruction. The technique involves deepithelializing and locally contouring mastectomy skin flaps to create a breast mound. The purpose of this study was to analyze outcomes in this cohort of patients. Methods: A review was performed on a prospective database of all patients who underwent postmastectomy Goldilocks reconstruction between June of 2017 and January of 2021 at a tertiary care center. Data queried included patient demographics, comorbidities, complications, outcomes, and subsequent secondary reconstructive surgery. Results: This series included 58 patients (83 breasts) who underwent Goldilocks reconstruction. Mean age at reconstruction was 56 years (range, 34 to 78 years), and 82% (48 patients) were obese (average body mass index, 36.8). When analyzed by individual breast, the overall complication rate was 18%. Most complications (n = 9), such as infection, skin necrosis, and seroma, were treated in the office. Six breasts experienced major complications (ie, hematoma and skin necrosis) requiring additional surgery. At the time of follow-up, 35% (n = 29) of breasts had a secondary reconstruction, consisting of 17 implants (59%), two expanders (7%), three fat grafts (10%), and seven autologous reconstructions (24%). The complication rate for secondary reconstruction was 14%. Conclusions: The Goldilocks breast reconstruction technique is safe and effective for high-risk breast reconstruction patients. Although early postoperative complications are limited, patients should be counseled on the likelihood of a subsequent secondary reconstruction procedure to achieve their desired aesthetic outcome.
Objectives To examine the long-term adherence to serial imaging of patients with sporadic vestibular schwannoma and analyze factors associated with being lost to follow-up. Study Design Retrospective chart review with telephone interview. Setting Single tertiary care center. Methods Patients with a sporadic vestibular schwannoma and started on observational surveillance management between January 2005 and December 2010 were included. Demographic data, tumor size, hearing and vestibular changes, and follow-up length were recorded. Patient factors were analyzed for association with being lost to follow-up. Results In total, 122 patients were included with a median length of follow-up of 5 months (range, 0-146). After initial surveillance, 22.1% (n = 27) of patients had a change in management to either microsurgery or radiosurgery. Of the remaining 77.9% (n = 95), nearly half (44.2%, n = 42) never returned for a second visit, and all but 3 were eventually lost to follow-up. There was no association between sex, race, age at diagnosis, initial tumor size, insurance status, household income, or driving distance to hospital and being lost to follow-up. Of 26 interviewed patients initially lost to follow-up, 11 (42.3%) sought care at another institution, 5 (19.2%) chose to no longer receive care, 1 (3.8%) had transportation difficulties, and 9 (36.4%) had poor understanding of their diagnosis or instructions. Conclusions The length of follow-up for patients undergoing surveillance of sporadic vestibular schwannoma varies widely, and patients are commonly lost to follow-up. Further efforts should be made to identify at-risk patients and provide adequate education to improve long-term surveillance.
A previously healthy 62-year-old African American female presented with a fulminant orbital cellulitis of the right eye with diffuse scleritis and orbital inflammation extending to the optic chiasm on neuroimaging. She was taken for an emergent orbitotomy with an orbital fat biopsy and started on broad-spectrum intravenous (IV) and topical antibiotics. Within 36 hours of presentation, scleral thinning and a corneal melt ensued, ending in enucleation. Intraoperative cultures were positive for Clostridium septicum, leading to a systemic work-up exposing a previously undiagnosed colon adenocarcinoma and metastatic multiple myeloma.
BACKGROUND:The Goldilocks breast reconstruction utilizes redundant mastectomy skin flaps to fashion a breast mound; however, imbrication of these skin flaps may predispose to fat necrosis and make detection of local breast cancer recurrence more difficult. Goldilocks patients follow a traditional post-mastectomy screening pathway that includes clinical examination for locoregional recurrence 1,2 , but it is unclear if this is sufficient. We evaluate our Goldilocks reconstruction case series to determine rates of diagnostic imaging, biopsy, locoregional and distant recurrence. METHODS:Sixty-six patients (94 breasts) undergoing Goldilocks breast reconstruction were retrospectively reviewed. Any diagnostic post-operative imaging/biopsies performed and confirmed local or distant breast cancer recurrence were noted.
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