A scoping review of the Goldilocks mastectomy

The Goldilocks mastectomy was originally developed as a "middle ground" between a breast reconstruction and a modified radical mastectomy, particularly for obese women who are poor candidates for direct breast reconstruction. This scoping review aims to provide an overview of surgical techniques, complications, cosmetic outcomes and patient-reported quality of life following the Goldilocks mastectomy.

Following the PRISMA-ScR guidelines a systematic search was conducted in March 2025, using PubMed and Embase. The identified studies were screened by two independent reviewers, based on predefined inclusion and exclusion criteria. Data focusing on surgical technique, complications and outcomes was extracted and recorded.

Fourteen articles were included, representing a total of 486 women (758 breasts). The majority were retrospective cohort studies. The Goldilocks mastectomy techniques reported varied, with some studies describing modifications to add more volume or cause less scarring. Common complications included seroma, wound dehiscence and fat necrosis. Four studies reported on secondary surgeries for volume enhancement. Three studies assessed cosmetic outcomes, which showed mixed results. Patient-reported quality of life, measured using the BREAST-Q, showed scores comparable to traditional reconstruction techniques.

Goldilocks mastectomy provides a safe reconstructive option, especially for obese patients. Complication rates are comparable to those found in traditional mastectomy techniques and patient satisfaction appears favorable. However, limited high-quality evidence exists regarding long-term cosmetic outcomes and quality of life measurements. Further research using more standardized outcome measures is needed to fully evaluate the pros and cons of the Goldilocks mastectomy in breast reconstruction.