Goldilocks Mastectomy with Bilateral In Situ Nipple Preservation Via Dermal Pedicle

Abstract

Summary:Patients who don’t want or can’t have formal breast reconstruction after mastectomy surgery can be considered for a Goldilocks mastectomy, where the breast fullness is recreated from what is left behind after the gland tissue is removed from underneath the skin in a breast reduction pattern. A Goldilocks mastectomy does not require the use of implants or tissue transfer from other parts of the body and may be completed in a single surgery. This is best suited for larger breasted women who are willing to have much smaller breasts as a result. Previously, it was a challenge to be able to preserve the nipples when this operation was performed; however, this article describes a patient who had a bilateral Goldilocks mastectomy for right breast cancer who was able to save her nipples by keeping the blood flow in place from the surrounding skin. Conventional breast reconstruction after mastectomy is a challenge for larger breasted women. The Goldilocks mastectomy technique was designed to make best use of the redundant lower pole skin and subcutaneous fat to recreate a breast mound without a prosthetic implant or autologous tissue transfer. In its original description, the Goldilocks mastectomy did not include a means for nipple preservation. In this report, we describe the further refinement of the Goldilocks procedure that preserves the nipple areolar complex using a dermal pedicle. A patient with large pendulous breasts and right breast carcinoma underwent a bilateral Goldilocks nipple-sparing mastectomy and immediate reconstruction without an implant or flap.

The Goldilocks Procedure with and without Implant-Based Immediate Breast Reconstruction in Obese Patients: The Mayo Clinic Experience

“…The Goldilocks procedure appears to be a reasonable and feasible option for obese patients, particularly those with ptotic breasts, seeking postmastectomy breast reconstruction; there is still a paucity of published literature regarding indications for and outcomes of this procedure. [11][12][13][14][15][16][27][28][29][30][31][32][33] Possibly one of the reasons for its lag within the surgical community and failure to permeate through many institutions may lie in its relatively recent description. However, one of the greatest concerns is that this procedure does not represent a full reconstruction, because it is not a traditional reconstruction.…”

Immediate Breast Reconstruction Using the Goldilocks Procedure: A Balance between More Surgery and Patient Satisfaction

“…Since its description in 2012, the Goldilocks procedure has become an increasingly used technique for postmastectomy breast reconstruction. 2,3,5,10,14–24 However, there has been no literature describing patient-reported outcomes and whether additional operations were required for these patients after the Goldilocks procedure. This option is frequently offered as a single-stage operation to patients with high body mass indexes and medical comorbidities that make them poor candidates for more complex options including implant-based and autologous breast reconstruction.…”

Goldilocks Mastectomy: The Middle Road Option for Obese Breast Cancer Patients

“…Further advancements have allowed the preservation of the nipple-areolar complex using a dermal pedicle or a Skin-sparing, Wise patterns, Internal Mammary perforator (SWIM) flap [13][14][15]. Goldilocks mastectomy has also been employed as a baseline for secondary breast reconstruction procedures and as a salvage option for failed reconstructions or as a bridge to secondary reconstructive procedures [8].…”