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

Bustos, Samyd S.; Nguyen, Minh Doan T.; Harless, Christin A.; Tran, Nho V.; Martinez‐Jorge, Jorys; Lin, Jason; Forte, Antonio J.; Casey, William J.; Boughey, Judy C.; Gray, Richard; Manrique, Oscar J.

doi:10.1097/prs.0000000000008362

Cited by 8 publications

(7 citation statements)

References 31 publications

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“…The authors showed the application of the Goldilocks technique can have a complication rate as high as 18% in high-risk patients. These complication rates are higher than those reported by Chaudhry et al 4 and Bustos et al 5 in obese patients. The authors attribute it to the higher prevalence of diabetes and higher body mass index, which may be contributing factors; however, the univariate and multivariate analyses did not yield any significant associations between clinical comorbidities and risk of developing complications after the initial procedure.…”

contrasting

confidence: 55%

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

Montorfano,

Mascaro Pankova

2023

Plastic &Amp; Reconstructive Surgery

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contrasting

confidence: 55%

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

Montorfano,

Mascaro Pankova

2023

Plastic &Amp; Reconstructive Surgery

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“…The largest and most recent report published in 2021 by Bustos et al compared cohorts of patients who underwent Goldilocks-only versus Goldilocks with direct implant placement among 105 patients and identified higher rates of complications with direct implant placement. 10 Another report written in 2019 by Chaudhry et al demonstrated an overall complication rate of 9.38% among a cohort of 53 patients with average BMI of 33, including seroma, hematoma, cellulitis, wound dehiscence, and reoperation. 7 In the original description of the Goldilocks technique in 50 breasts (32 patients) with average BMI of 30 by Richardson and Ma in 2012, the most frequent complications were cellulitis (three of 50), seroma (one of 50), and fat necrosis (one of 50).…”

Section: Discussionmentioning

confidence: 99%

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

Ghanouni

Thompson

Losken

2023

Plastic &Amp; Reconstructive Surgery

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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.

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“…There is a paucity of cases describing patients who have ptotic breasts and desire NAC preservation with implantbased reconstruction, but are not candidates for staged reoperation. Since its original report, the Goldilocks technique has been modified and adapted in several ways, to include use of implant-based reconstruction, NAC viability or free nipple grafts, and the addition of ADM (7)(8)(9). This case report presents the detailed technique of using an inferior adipodermal flap in immediate pre-pectoral implant-based reconstruction to achieve an aesthetically pleasing and safe outcome in patients with ptotic breasts who desire NAC preservation.…”

Section: Discussionmentioning

confidence: 99%

Modified goldilocks nipple-sparing mastectomy with immediate prepectoral implant-based reconstruction: a case report

Bovill¹,

Deldar²,

Wang³

et al. 2022

Gland Surg

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Background: Nearly 80% of women who undergo post-mastectomy reconstruction opt for implant-based reconstruction. Preservation of the nipple-areolar complex (NAC) in nipple-sparing mastectomy (NSM) significantly improves patient satisfaction; however in women with macromastia or breast ptosis, NAC preservation carries an increased risk of nipple ischemia. Traditional options have included free nipple grafts or a staged reconstruction, however in patients with aggressive or multifocal breast cancer, this is not feasible due to the need for timely oncologic resection. The Goldilocks mastectomy, which utilizes redundant adipodermal tissue to recreate a breast mound, was originally designed for women with large or ptotic breasts who did not desire post-mastectomy reconstruction. However, this technique has been modified in several ways. In this case report, we present our approach to a patient with breast ptosis and multifocal breast cancer who desired NAC preservation, volume preservation and mastopexy using the modified Goldilocks technique with pre-pectoral implant-based reconstruction.Case Description: A 38-year-old woman, with a bra size of 36C, presented with grade II, multifocal, estrogen receptor positive, progesterone receptor negative, human epidermal growth factor receptor-2 positive right breast infiltrating ductal carcinoma. The patient's aesthetic goals included: preservation of the NACs, elevation of NAC position, reduction in areola diameter, and maintenance of breast volume using implant-based reconstruction. As a result of her multifocal breast cancer, she was not a candidate for staged mastopexy followed by mastectomy and reconstruction. Therefore, the patient underwent bilateral Goldilocks NSM, right sentinel lymph node biopsy, and immediate implant-based reconstruction using the modified Goldilocks technique with acellular dermal matrix (ADM). At 3-month follow-up, the patient was satisfied with the overall aesthetic outcome of her breasts. Conclusions:We present a patient with breast ptosis and multifocal breast cancer who desired NAC preservation and implant-based reconstruction, but was not a candidate for staged reoperation. This case report is the first to describe a modified Goldilocks NSM with pre-pectoral implant-based reconstruction.

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

Cited by 8 publications

References 31 publications

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

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

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

Modified goldilocks nipple-sparing mastectomy with immediate prepectoral implant-based reconstruction: a case report

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