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Goldilocks mastectomy is a type of surgical procedure for breast mound reconstruction using patient's autologous tissue without additional implants after the breast parenchyma has been removed for treatment of disease or prophylaxis. The procedure is an alternative approach to full breast reconstruction after mastectomy for women with breast cancer condition (or predisposed to it).[1][2][3]
Medical use
The Goldilocks mastectomy technique was first described in 2012 by the surgeons Heather Richardson and Grace Ma in the International Journal of Surgery.[1][4]It was first described as a surgical procedure to give women additional option to formal breast reconstruction after mastectomy. The procedure was first applied to some patients who did not qualify for traditional breast reconstruction methods because of medical complications such as history of radiation exposure from prior breast conservation treatment (lumpectomy) or due to the risks associated with high body mass index or because of personal preference.The method is mostly intended for patients with macromastia or ptosis as it presumes having redundant cutaneous flaps and applies preservation of de-epithelialized tissue technique.[5][6] [7][8][9][10] According to the Archives of Plastic Surgery, "..Goldilocks mastectomy can also be used as secondary operation after initial failing in formal breast reconstruction..."[4] 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.[1]North Eastern Society of Plastic Surgeons also concludes: "Goldilocks breast reconstruction is an option in patients with higher than average BMI or excess local breast tissue, or in patients meeting these criteria preferring a single-stage reconstruction".[11] The limitations of procedure (shortage of skin or residual fat), resulted in integration of goldilocks mastectomy in more complex surgery techniques such as lateral intercostal artery perforator (LICAP) flap augmentation.[12]
Advantages and benefits
Patients who are good candidates for the Goldilocks mastectomy can have a simplified surgical approach that recreates the fullness of a breast without additional complex surgeries or the need for artificial implants. Those who felt their breasts were too large to begin with are in some cases more satisfied with a smaller and more lifted appearance.[1][5]
Disadvantages and risks
The final size and appearance of the residual tissue arrangement cannot be predicted or chosen specifically, leaving some patients with a smaller appearance of breasts than they might choose to have. Although the procedure benefits some patients, regular medical complications have also been reported by different sources. According to Journal of Surgical Oncology, "The overall complication rate was 9.38% (seroma = 2, hematoma = 1, cellulitis = 2, wound dehiscence = 3, and operating room take back = 1)".[13]Following close observation of 172 Goldilocks mastectomy procedures, the North Eastern Society of Plastic Surgeons came to relatively similar results.[11][8] However this is no different to the overall complication rates associated with conventional mastectomy methods.[14]Patients with ptosis of the breast, very large breasts, or high body mass index are better suited to have more residual tissue after mastectomy, while patients who have smaller breasts may not be suited for the procedure.[8]
External links
References
- ^ a b c d Richardson, Heather; Ma, Grace (2012). "The Goldilocks mastectomy". International Journal of Surgery. 9 (10): 522–526. doi:10.1016/j.ijsu.2012.08.003.
- ^ Plastic Reconstruction Surgery: Goldilocks Mastectomy with Bilateral In Situ Nipple Preservation Via Dermal Pedicle (Heather Richardson, MD and Joel A. Aronowitz, MD, 2018)
- ^ PRS: Total Single-Stage Autologous Breast Reconstruction with Free Nipple Grafts (Jean-Claude D. Schwartz, MD, PhD and Piotr P. Skowronski, MD, 2015)
- ^ a b Jaikel Zavala, Karina; Geun Kwon, Jin; Ho Han, Hyun; Key Kim, Eun; Sup Eom, Jin (2019). "The Goldilocks technique: An alternative method to construct a breast mound after prosthetic breast reconstruction failure". Archives of Plastic Surgery. 46 (5): 475–479. doi:10.5999/aps.2018.00808. PMC 6759440. PMID 31042862.
- ^ a b International Open Access Journal of the American Society of Plastic Surgeons: Goldilocks Mastectomy: A Safe Bridge to Implant-Based Breast Reconstruction in the Morbidly Obese (Jean-Claude Schwartz, 2017)
- ^ Ovid/Annals of Plastic Surgery: Moffitt Cancer Center Experience of Tissue Expander Breast Reconstruction: Does Acellular Dermal Matrix Increase Return to the Operating Room?
- ^ Journal of the American Society of Plastic Surgeons: Partial Breast Reconstruction with Goldilocks Technique After Excision of Giant Fibroadenoma: A Case Report (Ryan P. Ter Louw, MD,* Sara B. Bruce, MD,† and Maurice Y. Nahabedian, 2017)
- ^ a b c Asian Journal of Surgery: Goldilocks mastectomy for obese Japanese females with breast ptosis (Tomoko Ogawa, 2015)
- ^ International Journal of Surgery: Case report of a definitive autologous reconstruction in a patient requiring immediate postoperative anticoagulation and reduced operative time (Jean-Claude Schwartza and Piotr P. Skowronsk, 2016)
- ^ Wiley Online Library: Extending the Indications for Autologous Breast Reconstruction Using a Two‐Stage Modified Goldilocks Procedure: A Case Report (Jean‐Claude D. Schwartz MD, PhD; Piotr P. Skowronksi MD., 2016)
- ^ a b NESPS: Outcomes Analysis of Goldilocks Mastectomy and Breast Reconstruction: A Single Institution Experience of 172 Cases
- ^ Plastic and Reconstructive Surgery: Toward a More Definitive Goldilocks Mastectomy: Simultaneous Addition of the Lateral Intercostal Perforator Flap (Schwartz, Jean-Claude D. MD, PhD, 2019)
- ^ Journal of Surgical Oncology: Outcomes analysis of Goldilocks mastectomy and breast reconstruction: A single institution experience of 96 cases (Arif Chaudhry MD, Jeremie D. Oliver, Krishna S. Vyas MD, PhD, Saad A. Alsubaie MD, Oscar J. Manrique MD, Jorys Martinez‐Jorge MD, 2019)
- ^ NCBI Medicine: Postoperative outcomes of breast reconstruction after mastectomy (A retrospective study)