Outcomes Analysis of Goldilocks Mastectomy and Breast Reconstruction: The Mayo Clinic Experience
Jeremie Oliver, BS, BA, Arif Chaudhry, MD, Saad Alsubaie, MD, Jorys Martinez-Jorge, MD.
Mayo Clinic, Rochester, MN, USA.
PURPOSE: The Goldilocks mastectomy procedure involves local contouring of completely autologous breast tissue created by preserving and de-epithelializing the residual mastectomy flap. This technique provides patients with an option for post-mastectomy breast reconstruction alternative to simple mastectomy without reconstruction, complex autologous flap harvesting techniques, or the use of artificial implants. The purpose of this study was to provide outcomes data for 172 Goldilocks mastectomy procedures performed at a single tertiary academic center analyzing complication rate, relevant comorbidities, and adjuvant cancer treatment impacting functional and aesthetic outcomes. This is the largest series of Goldilocks mastectomy procedures to be reported to date.
METHODS: Relevant comorbidities and complication data were collected. Patients who had prior surgical procedures before presenting to our institution were designated as such. Specific breast cancer pathology and previous breast therapy were indicated. Data relevant to the Goldilocks reconstruction at our institution were collected, including laterality of procedure(s), indication (i.e. prophylactic or therapeutic), whether a tissue expander or an implant was placed at the time of the Goldilocks procedure or at any point following the procedure, the number of procedures needed for the entire reconstructive regimen, and any specific revision procedures, if needed (i.e. fat grafting, mastopexy, augmentation, or scar revision).
RESULTS: A total of 95 patients underwent reconstruction with Goldilocks procedure. 82.1% (78) of cases were bilateral, and 17.8% (17) were unilateral reconstructions. Breast cancer pathology results included: DCIS 27.3% (26), LCIS 5.26% (5), stage I 11.57 (11), stage II 23.1% (22), stage III 23.1% (22), inflammatory 5.3% (5), BRCA prophylactic 11.5% (11), other 2.1% (2), and recurrent cancer 6.3% (6). Pre-operative radiation therapy was given in 7.4% (7) of patients, while post-operative radiation therapy was given to 6.31% (6) of patients. 22.1% (21) of patients received chemotherapy and 17.8% (17) received hormone therapy. Previous breast reconstruction history included implant-based reconstruction in 3.15% (3), autologous 1% (1), multiple attempts 1% (1), and failed reconstruction 1% (1). Reconstruction types included Goldilocks-only in 58% (53) of patients, Goldilocks + tissue expander in 35.8% (34), and Goldilocks with implant in 10.5% (10). 45.3% (43) of patients underwent adjuvant fat grafting, 7.3% (7) underwent concurrent mastopexy, 5.2% (5) underwent concurrent breast augmentation, and 14.7% (14) had scar revision procedures performed at the time of Goldilocks procedure. Complications included: seroma 6.3% (6), hematoma 4.2% (4), cellulitis 4.2% (4), wound dehiscence 4.2% (4), DVT/PE 1% (1), readmission 1% (1), needed take back to OR 9.5% (9), needed explant 7.4 %( 7), or other complications 3.1% (3).
CONCLUSION: Goldilocks mastectomy procedures are a useful adjunct in reconstruction, and can also be used in implant-based reconstruction, providing a dermal sling to build an internal bra and scaffold for the implant. Patients who have relevant medical comorbidities or who decline traditional methods of reconstruction can greatly benefit from Goldilocks mastectomy. There may be substantial utility in considering Goldilocks procedures during pre-operative planning in patient-centered care along the reconstructive ladder, as this approach has the ability of being modified with additional procedures such as fat grafting or implant placement.
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