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

Abstract

Background: Since its first description in 2012, the Goldilocks procedure has become an option for immediate breast reconstruction, particularly for obese patients who are poor candidates for traditional implant or autologous reconstruction. In this work, the authors performed a longitudinal study of patients who underwent mastectomy with Goldilocks reconstruction to assess the incidence of additional surgical procedures, and to assess surgical outcomes and patient satisfaction. Methods: A retrospective review of patients who underwent mastectomy with the Goldilocks procedure only at Mayo Clinic Rochester between January of 2012 and September of 2019 was performed. Demographics, complications, additional breast procedures performed to attain the final results, and patient-reported outcomes using the BREAST-Q were recorded. Univariate and multivariable analyses were performed to identify statistical associations and risk factors. Results: Sixty-three patients (108 breasts) were included. Mean age was 57.8 years. Mean body mass index was 37.6 kg/m2. Median follow-up time after the mastectomy with the Goldilocks procedure was 15 months. The major complication rate within the first 30 days was 9.3 percent. Forty-four breasts (40.7 percent) underwent additional surgery. Dyslipidemia was significantly associated with an increased risk of additional surgery (adjusted hazard ratio, 2.00; p = 0.045). Scores in the four BREAST-Q domains were not statistically different between patients who had additional procedures and those who did not. Conclusions: Based on the results, the authors recommend a thorough preoperative discussion with patients who are candidates for the Goldilocks procedure to explore all options for reconstruction and their expectations, because it is crucial to reduce the necessity for additional operations in this high-risk population. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.

Discussion: Outcomes of the Goldilocks Technique in High-Risk Breast Reconstruction Patients

“…The present study had one of the highest numbers of patients enrolled, surpassed only by the recent study by Manrique et al, 3 which had a higher number of cases/breasts. The study and conclusions are relatively similar and validate the present study.…”

“…In direct conjunction with the above-mentioned comment, the small sample size of this article may potentially compromise the validity of the conclusions that can be drawn. 3 Also, there is some heterogeneity between patient body mass indexes (range, 25.5 to 55) that is not represented by enough statistical significance, and the fact that no statistical difference was found regarding comorbidities raises questions and may be a potential source of bias. The study focused on relatively immediate postoperative outcomes and not on longer-term follow-up complications.…”

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

“… 16 The Goldilocks procedure has fewer complications and a shorter operating time. 16 17 Additionally, it can be selected as the first choice for single-stage operation of reduction in obese patients or patients with large breasts. 18 It is a safe bridge without complications even if a two-stage reconstruction is planned.…”

“…The Goldilocks procedure, published in 2012, is frequently offered as a single-stage operation for patients with high body mass indices and medical comorbidities that render them poor candidates for more complex options, including implant-based and autologous breast reconstruction [16]. The Goldilocks procedure has fewer complications and a shorter operating time [16,17]. Additionally, it can be selected as the first choice for single-stage operation of reduction in obese patients or patients with large breasts [18].…”

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

“…I read with interest a recent article by Manrique et al entitled “Immediate Breast Reconstruction Using the Goldilocks Procedure: A Balance between More Surgery and Patient Satisfaction.” 1 I congratulate the authors on their long-term follow-up of these challenging cases. They state that although the Goldilocks mastectomy is touted as a single-stage reconstructive option for high-risk patients, nearly 40% of their patients required additional surgery and still had similar satisfaction when compared to the Goldilocks-only group.…”