“Outcomes of the Goldilocks technique in High-risk Breast Reconstruction Patients.”

Abstract

mong the variety of techniques used for breast reconstruction following skin-sparing mastectomy for patients with breast cancer, a few are ideal for patients at high risk of complications. [1][2][3] The original Goldilocks technique, as described by Richardson and Ma in 2012, sought to provide a safe and efficacious alternative for these patients. By folding and shaping mastectomy skin flaps into a breast mound without implants or tissue from other areas of the body, this technique avoids complications traditionally associated with prosthetic and autologous methods of reconstruction (Fig. 1). Although, compared with more complex methods, the Goldilocks technique offers less control of reconstructive shape and volume, for many patients, it is more desirable than no reconstruction, a safe alternative that for high-risk patients may be "just right." 4 As obesity rates top 15% globally and the incidence of yearly female breast Background: The Goldilocks technique seeks to provide a safe alternative for patients who are otherwise at risk of adverse complications during reconstruction. The technique involves deepithelializing and locally contouring mastectomy skin flaps to create a breast mound. The purpose of this study was to analyze outcomes in this cohort of patients. Methods: A review was performed on a prospective database of all patients who underwent postmastectomy Goldilocks reconstruction between June of 2017 and January of 2021 at a tertiary care center. Data queried included patient demographics, comorbidities, complications, outcomes, and subsequent secondary reconstructive surgery. Results: This series included 58 patients (83 breasts) who underwent Goldilocks reconstruction. Mean age at reconstruction was 56 years (range, 34 to 78 years), and 82% (48 patients) were obese (average body mass index, 36.8). When analyzed by individual breast, the overall complication rate was 18%. Most complications (n = 9), such as infection, skin necrosis, and seroma, were treated in the office. Six breasts experienced major complications (ie, hematoma and skin necrosis) requiring additional surgery. At the time of follow-up, 35% (n = 29) of breasts had a secondary reconstruction, consisting of 17 implants (59%), two expanders (7%), three fat grafts (10%), and seven autologous reconstructions (24%). The complication rate for secondary reconstruction was 14%. Conclusions: The Goldilocks breast reconstruction technique is safe and effective for high-risk breast reconstruction patients. Although early postoperative complications are limited, patients should be counseled on the likelihood of a subsequent secondary reconstruction procedure to achieve their desired aesthetic outcome.

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

“…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. The Goldilocks technique offers shorter operating time, shorter recovery, greater cost-effectiveness, and requires no additional donor site ( 15 ). In this manner, this technique minimizes the complications of both implant- based and abdominally based autologous reconstruction, however may still be used in the setting of implant or autologous reconstruction.…”

“…In this manner, this technique minimizes the complications of both implant- based and abdominally based autologous reconstruction, however may still be used in the setting of implant or autologous reconstruction. When used alone, there is no risk of implant infection, capsular contraction, implant rupture, and decreased risk of fat necrosis, superficial skin loss, and abdominal bulge or hernia ( 15 ). This technique has been shown to be a favorable option for patients with obesity, especially for patients who desire a smaller breast and do not want to undergo a full reconstruction ( 15 , 16 ).…”

“…When used alone, there is no risk of implant infection, capsular contraction, implant rupture, and decreased risk of fat necrosis, superficial skin loss, and abdominal bulge or hernia ( 15 ). This technique has been shown to be a favorable option for patients with obesity, especially for patients who desire a smaller breast and do not want to undergo a full reconstruction ( 15 , 16 ). Further, it is often necessary in the setting of revision after adjuvant radiation ( 15 ).…”

Current Outcomes in Breast Reconstruction

“…Ghanouni et al show a relatively low rate of complications using the Goldilocks procedure; however, they report that the majority of patients require a second procedure to complete the reconstruction. 4 Asaad et al compared outcomes in 694 two-stage prepectoral and subpectoral breast reconstructions, and found similar rates of complications and patient satisfaction. 5 In their prospective short-term quality-of-life assessment, Sadok et al found that despite increased rates of complications in autologous versus alloplastic breast reconstruction, patient satisfaction was higher…”

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

“…W e read with great interest the article "Outcomes of the Goldilocks Technique in High-Risk Breast Reconstruction Patients" by Ghanouni et al 1 The authors describe the technique outcomes, complications, and the likelihood of secondary reconstructive surgery in high-risk patients. There is growing evidence showing that obese patients are two to three times more prone to develop complications after breast reconstruction.…”