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

Abstract

Background:Reconstructive surgeons are encountering an increasing number of obese women requiring postmastectomy reconstruction. These patients are poor candidates for autologous and prosthetic-based reconstructions as they have a high rate of reconstructive failure, surgical complications, and poor aesthetic outcomes. We demonstrate here the utility of the previously described Goldilocks mastectomy with free nipple grafts as a safe bridge to second stage implant-based breast reconstruction.Methods:Ten consecutive morbidly (BMI > 40) or super obese (BMI>50) women underwent bilateral Goldilocks mastectomy with free nipple grafts followed by second stage subpectoral implant placement at least three months postoperatively. Patients were assessed for implant-related complications including malposition, capsular contracture, dehiscence, and extrusion.Results:Ten postmastectomy reconstructions in patients with BMIs ranging from 37 to 50 with a mean BMI of 45 underwent bilateral Goldilocks mastectomy with free nipple grafts. Two patients had wound healing complications after Goldilocks mastectomy but were completely healed within 8 weeks. There were no instances of delayed wound healing or reconstructive failure after prosthetic placement. With at least 9 months of follow-up on all patients, no patient has had a capsular contracture, significant malposition, or other complication requiring reoperation.Conclusion:The obese patient poses a significant reconstructive challenge for which no reproducible approach has been described. Here, we present a 2-stage strategy: the previously described Goldilocks mastectomy with free nipple grafts followed by second stage subpectoral definitive implant placement. This is the first proposed description of a reliable strategy for postmastectomy reconstruction in the morbidly and super obese.

Oncoplastic Approach to Giant Benign Breast Tumors Presenting as Unilateral Macromastia

“… 8 In this, skin sparing mastectomy done through wise incisions utilizes the residual cutaneous flaps to auto-augment the breast mound. 9 Despite minor discrepancies in NAC levels in both cases, long-term symmetry and patient satisfaction were excellent…”

The Goldilocks technique: An alternative method to construct a breast mound after prosthetic breast reconstruction failure

“…Postmastectomy reconstruction is typically performed using implant-based techniques [1,5,10,11]. Although the majority of patients have a completely uneventful postoperative course, unfortunately, some patients experience complications [12], one of the most common of which is seroma development [12].…”

Toward a More Definitive Goldilocks Mastectomy: Simultaneous Addition of the Lateral Intercostal Perforator Flap

“…In only a small percentage of women who are large breasted, with ptosis and elevated BMI, can a reconstructed breast of appropriate volume and proportion be constructed in a single stage. 8 We have previously shown that second-stage implant placement 9 or lipotransfer 10 can enhance the final result but carry with them the risks of a prosthetic and the more than likely need for additional fat-grafting surgeries, respectively. These approaches, at a minimum, require 2 surgical procedures.…”

“…The donor site morbidity associated with the LICAP flap is minimal and does not have the same wound breakdown rate as a latissimus flap where the skin is often undermined, and the muscle mobilized. 9…”