Goldilocks Procedure without a Vertical Incision and a Comprehensive Literature Review

Abstract

Background: The Goldilocks technique is a postmastectomy breast reconstruction procedure adopted in 2012, which is performed by preserving and de-epithelializing the residual mastectomy flap to create an autologous tissue breast mound using an anchor, inverted T, or lateral incision. It is utilized in select patients along with the addition of a free nipple graft, fat grafting, and/or tattoo. A novel technique using the Goldilocks procedure offers promising postoperative results as a more aesthetic alternative. The purpose of this study was to perform a literature review on the healing outcomes and patient satisfaction of the Goldilocks procedure along with presenting our approach using a horizontal inframammary incision without a vertical incision. Methods: A retrospective chart review of patients presenting to a single surgeon for breast reconstruction surgery using the Goldilocks procedure without a vertical incision from March of 2018 to October of 2020 was performed. A narrative literature review on surgical techniques and outcomes was also conducted. Results: Three cases of breast reduction using the Goldilocks procedure without a vertical incision are described. From the literature search, 13 articles inclusive of 222 patients were identified. Conclusions: The Goldilocks procedure without a vertical incision can be performed in patients with large breasts for breast reconstruction postmastectomy. It is possible to utilize the superior flap in conjunction with the de-epithelialized inferior flap of the breast and obtain good projection with this method. Furthermore, avoidance of the vertical incision reduces breakdown at the T-junction and is aesthetically beneficial.

Management of Gestational Gigantomastia with Goldilocks Procedure after Mastectomy: A Case Report and Review of Literature

“…Therefore, we referred to Becker et al's Goldilocks procedure without a vertical incision rather than the traditional wise pattern of Goldilocks. 15 Various surgical methods have been used to treat gigantomastia. However, there have been no reports of the use of the Goldilocks procedure.…”

“…After skin-sparing mastectomy, it was determined that vertical halving incision would be detrimental to flap survival because the mastectomy flap was tubularly long. Therefore, we referred to Becker et al's Goldilocks procedure without a vertical incision rather than the traditional wise pattern of Goldilocks [15]. Various surgical methods have been used to treat gigantomastia.…”

“…Becker et al have reported the Goldilocks procedure without a vertical incision. 15 We performed the operation using this method. Skin markings were performed in an upright position before entering the operating room.…”

Breast reconstruction after mastectomy in patients with obesity: a narrative review

“…As they have a significant degree of ptosis, they should be counseled about the higher risk of nipple and mastectomy flap necrosis ( 11 ). Redundancy of the mastectomy flap can be managed with a skin reducing mastectomy ( 12 ), most commonly utilizing an inverted T incision (Wise Pattern) that allows for reduction of skin in both horizontal and vertical vectors and minimization of the amount of dysvascular tissue retained ( 13 ). These incision patterns require a close discussion and coordination with the oncologic breast surgeon.…”

“…Specifically, de-epithelized redundant inferior dermal flaps are used for lower pole coverage, soft tissue support and auto-augmentation, while the superior medial and lateral flaps portion of the inferior dermal flap is folded over to create a reconstructed breast mound. It takes advantage of a vascularized inferior dermal flap and addresses both redundant mastectomy skin while also diminishing the resulting extensive dead space in the prepectoral space following mastectomy ( 12 ). These inferior dermal flaps and the mastectomy skin flaps provide a substrate for future serial fat grafting to further augment the reconstruction to create the breast mound.…”