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

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.

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.

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%.

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.

Therapeutic, IV.