The Goldilocks mastectomy

Richardson, Heather; Ma, Grace

doi:10.1016/j.ijsu.2012.08.003

Cited by 44 publications

(66 citation statements)

References 12 publications

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“…We further expand upon this approach as a first‐line single‐stage reconstructive option for patients, regardless of BMI and other comorbidities before surgery. The first documented series of patients who underwent Goldilocks mastectomy and reconstruction was published in 2012 by Richardson and Ma …”

Section: Discussionmentioning

confidence: 99%

“…They documented a complication rate of 8%, reporting one patient with seroma and three patients with cellulitis, similar to our complication rate of 9.38%. The authors describe their approach to mastectomy and reconstruction as a technique offered to patients of advanced age and/or high BMI (>35), as they may have more difficulty tolerating more extensive reconstructive approaches, such as autologous free‐tissue transfer …”

Section: Discussionmentioning

confidence: 99%

“…The authors describe their approach to mastectomy and reconstruction as a technique offered to patients of advanced age and/or high BMI (>35), as they may have more difficulty tolerating more extensive reconstructive approaches, such as autologous free-tissue transfer. 1 The next study to document Goldilocks mastectomy and reconstruction was published in 2013 by Ogawa in Japan, wherein the author reported the results of five female Japanese patients (age range, 67-76 years) with BMI above 25. 3 Positive aesthetic outcome was only reported in two of the five patients in this series, which was thought by the author to be due to severe obesity in the patients who did not paper published in 2016 again by Schwartz and Skowronski 5 described a two-stage Goldilocks approach specifically for individuals with a lower BMI with ptotic breasts.…”

Section: Discussionmentioning

confidence: 99%

“…First described in 2012, the “Goldilocks mastectomy” was designed to provide postmastectomy reconstruction to patients by locally contouring completely autologous breast tissue by preserving and de‐epithelializing the residual mastectomy flap to create a breast mound. The name Goldilocks was chosen because it embodies the simplicity of a single procedure with little downtime and yet preserves a breast mound without an amputated appearance.…”

Section: Introductionmentioning

confidence: 99%

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Outcomes analysis of Goldilocks mastectomy and breast reconstruction: A single institution experience of 96 cases

Chaudhry

Oliver

Alsubaie

et al. 2019

Journal of Surgical Oncology

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Background The Goldilocks mastectomy procedure involves local contouring of completely autologous breast tissue created by preserving and de‐epithelializing the residual mastectomy flaps. The purpose of this study was to provide outcomes data for 96‐Goldilocks mastectomy procedures analyzing indications, complications, relevant comorbidities, and adjuvant cancer treatment impacting reconstructive and aesthetic outcomes. Methods Comprehensive review of every patient who underwent Goldilocks mastectomy from 2012 to 2018 included relevant medical and surgical comorbidities, as well as complication profiles. Aesthetic outcomes were also assessed in those with postoperative imaging available. Results A total of 53 patients (96 breasts) were included in this study. Bilateral cases consisted of 81.1% of the total cohort (n = 86 cases), and 18.9% (n = 10 cases) were unilateral procedures. Mean age at the time of reconstruction was 55.8 (33‐77) years. Mean body mass index (BMI) at the time of reconstruction was 33.7 (19.2‐54.6). The overall complication rate was 9.38% (seroma = 2, hematoma = 1, cellulitis = 2, wound dehiscence = 3, and operating room take back = 1). Conclusions Goldilocks breast reconstruction is a safe, effective option in patients with higher than average BMI or excess local breast tissue, or in patients meeting these criteria preferring a single‐stage reconstruction. This study qualifies its use in patients with higher than average risk factors for more extensive reconstructive modalities.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Outcomes analysis of Goldilocks mastectomy and breast reconstruction: A single institution experience of 96 cases

Chaudhry

Oliver

Alsubaie

et al. 2019

Journal of Surgical Oncology

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show abstract

“…6 This technique involves a skin-sparing mastectomy through Wise incisions and utilizes the residual cutaneous mastectomy flaps to create a breast mound. We developed an updated version of this technique that includes a free nipple graft and aggressive sculpting of the inferior mastectomy flap with division of the lateral inframammary fold for medial tissue transfer to create a more central breast mound.…”

mentioning

confidence: 99%

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

Schwartz

2017

Plastic and Reconstructive Surgery - Global Open

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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.

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Patient and procedure characteristics associated with postoperative pain after prophylactic versus therapeutic ambulatory bilateral breast surgery

Simón

Assel

Serafin

et al. 2023

Journal of Surgical Oncology

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Background and ObjectivesWe investigated whether age, body mass index (BMI), and tissue expander placement were related to postoperative opioid requirement for patients undergoing therapeutic versus prophylactic breast surgery.MethodsPostoperative opioid consumption was evaluated for patients who underwent bilateral mastectomy with immediate implant‐based reconstruction at a freestanding ambulatory cancer surgery center between 2016 and 2021. Ordinal regression tested whether surgical indication was associated with increased postoperative opioid requirements after adjusting for age, BMI, and tissue expander placement.ResultsOf 2447 patients, 6% underwent prophylactic surgeries. Therapeutic mastectomy patients had lower postoperative opioid requirement (OR = 0.67; 95% CI: 0.50−0.91; p = 0.030), but this was not significant after adjusting for covariates (OR = 0.75; 95% CI: 0.53−1.07; p = 0.2). Opioid use increased with higher BMI (OR = 1.06; 95% CI: 1.05−1.08; p < 0.001) and decreased with age (OR = 0.97; 95% CI: 0.96−0.98; p < 0.001) with therapeutic mastectomy patients being older (median 46 vs. 39). The subpectoral tissue expander group had nearly double the postoperative opioid requirement compared to prepectoral placement (OR = 1.86; 95% CI: 1.55−2.23; p < 0.001).ConclusionsIncreased postoperative opioid requirement in women undergoing prophylactic procedures is best explained by age. Mastectomy patients should be counseled similarly about postoperative pain irrespective of indication. A larger prophylactic mastectomy sample is required to provide more precise estimates.

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The Goldilocks mastectomy

Cited by 44 publications

References 12 publications

Outcomes analysis of Goldilocks mastectomy and breast reconstruction: A single institution experience of 96 cases

Outcomes analysis of Goldilocks mastectomy and breast reconstruction: A single institution experience of 96 cases

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

Patient and procedure characteristics associated with postoperative pain after prophylactic versus therapeutic ambulatory bilateral breast surgery

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