Extending the Indications for Autologous Breast Reconstruction Using a Two-Stage Modified Goldilocks Procedure: A Case Report

Abstract

Post-mastectomy reconstruction is performed using implant-based or autologous techniques. Many women refuse or are poor candidates for implant-based reconstruction. We previously described a single-stage autologous technique that was most applicable in obese women with significant ptosis that made use of the mastectomy skin flap and subcutaneous tissue to reconstruct a breast mound. Here, we extend this technique to smaller breasted women by incorporating a second stage of skin tailoring and fat grafting. This technique does not require donor site surgery nor extended operative and recovery times. It extends the indications for autologous reconstruction to nonideal candidates and to developing countries where cost limits access.

Outcomes analysis of Goldilocks mastectomy and breast reconstruction: A single institution experience of 96 cases

“…The claim was then made by the authors that the Goldilocks approach is an excellent option for someone who requires immediate postoperative anticoagulation and/or abbreviated operative times . While previous reports of successful Goldilocks procedures had focused on the obese patients with substantial local breast tissue available postmastectomy to create a new breast mound, a paper published in 2016 again by Schwartz and Skowronski described a two‐stage Goldilocks approach specifically for individuals with a lower BMI with ptotic breasts. The second stage described in this case report entails additional skin tailoring around the modified mastectomy flap as well as fat grafting.…”

“…The second stage described in this case report entails additional skin tailoring around the modified mastectomy flap as well as fat grafting. This two‐stage approach potentially allows for the extended opportunity for nonideal candidates to undergo autologous breast reconstruction without the donor site morbidity involved in the free‐tissue transfer . In 2017, another case report described the utilization of the Goldilocks mastectomy approach for the breast after removal of a giant fibroadenoma, which allowed for successful reconstruction without the need for placement of prosthesis or creation of an additional donor site .…”

“…This two-stage approach potentially allows for the extended opportunity for nonideal candidates to undergo autologous breast reconstruction without the donor site morbidity involved in the free-tissue transfer. 5 In 2017, another case report described the utilization of the Goldilocks mastectomy approach for the breast after removal of a giant fibroadenoma, which allowed for successful reconstruction without the need for placement of prosthesis or creation of an additional donor site. 4 The most recent article describing the Goldilocks approach to mastectomy and reconstruction again addresses the utility of this technique in obese patients seeking IBR following mastectomy, as these patients are typically nonideal candidates for autologous free-tissue transfer due to multiple medical and surgical comorbidities.…”

An alternative method to create a breast mound after tissue expander insertion: The modified Goldilocks technique

“…2, 3). This method is similar to the previously reported Goldilocks technique, with a slight modification to the upper pole skin to add volume [10,11]. After skin closure, the patient's depression was completely corrected and it was possible to create a breast mound, although it was relatively low.…”

Goldilocks Mastectomy: A Safe Bridge to Implant-Based Breast Reconstruction in the Morbidly Obese

“…Most women require additional volume supplementation, some of whom can be accommodated with lipotransfer surgery. 9 However, most obese women require significant additional volume that must be supplied by an implant or flap. Here, we present successful implant-based reconstruction in 10 consecutive women who were either morbidly obese or super obese [body mass index (BMI), 37–50; average, 45].…”