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Breast Reconstruction With Goldilocks Procedure: Is It The First Or Final Step Of The Breast Reconstruction Journey?
Doga Kuruoglu, MD1, Samyd S. Bustos, MD1, Maria Yan, MD1, Antonio J. Forte, MD,PhD,Ms2, Minh-Doan T. Nguyen, MD, PhD1, Jorys Martinez-Jorge, MD1, Christin Harless, MD1, Nho V. Tran, MD1, Judy C. Boughey, MD1, Oscar J. Manrique, MD, FACS1.
1Mayo Clinic, Rochester, MN, USA, 2Mayo Clinic, Jacksonville, FL, USA.

Purpose: Since its first description by Dr. Richardson in 2012, breast reconstruction with the Goldilocks procedure has become a notable surgical option, particularly for patients who are poor candidates for traditional post-mastectomy reconstruction, such as obese women or women with very large, ptotic breasts. The Goldilocks procedure is not a full reconstruction. Hence, these patients may require additional reconstructive surgeries for volume supplementation, which may increase the risk of complications. In this study, we performed long term follow-up on patients who underwent mastectomy with Goldilocks-only reconstruction and assess the rate of additional surgical procedures and compare surgical outcomes and satisfaction.
Methods: Retrospective review of patients who underwent mastectomy and Goldilocks-only procedure at our institution between 2014 and 2019 was performed. We assessed the rate of additional breast procedures performed to reach the final reconstruction in those patients. Demographics, clinical and surgical characteristics, complications, and patient-reported outcomes (BREAST-Q) were compared.
Results: A total of 68 patients (116 breasts) were included in this study. Of the total cohort, 82.7% (n = 96 cases) were bilateral and 17.3% (n = 20 cases) were unilateral procedures. Mean age at the time of reconstruction was 57.7 years (33 77 years). Mean body mass index (BMI) at the time of reconstruction was 37.8 kg/m2 (19.2 62 kg/m2). The mean follow-up time after the Goldilocks procedure was 18.9 months (6 52 months). Eighteen (15.5%) breasts received radiotherapy after Goldilocks. The overall 6-months complication rate was 12.9% (n=15 cases, seroma=7, hematoma=1, cellulitis=5 and skin flap full necrosis=2). A total of 44 breasts (37.9%) underwent additional surgery (fat grafting, breast revision, reconstruction). Fat grafting was the most common additional surgery (n=40 cases, 34.4%). Ten cases underwent revision (8.6%). A total of 5 (4.3%) breasts underwent delayed implant reconstruction, 2 (1.7%) autologous free flap reconstruction (deep inferior epigastric artery perforator flap), and 2 (1.7%) pedicled lateral intercostal artery perforator flap reconstruction. The mean interval time between the Goldilocks procedure and the additional surgery was 6 months (7 days 36 months). Six (0.5%) cases had immediate nipple reconstruction with local flaps during Goldilocks procedure. Average patient satisfaction in these patients was 60.4% (SD=17.21). No statistical difference was found in patient satisfaction, physical, psychological and sexual well-being between patients who had additional breast procedures and those who did not.
Conclusions: Even though Goldilocks is a safe, single-staged breast reconstructive option for patients that are poor candidates for traditional post-mastectomy breast reconstruction, additional surgeries are still required in a high percentage to achieve final breast reconstruction.


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