Risk factors affecting tissue expander use and nipple areolar complex sparing in Goldilocks mastectomy

Area of Science:

• Plastic Surgery
• Reconstructive Surgery
• Oncology

Background:

• The Goldilocks mastectomy reconstructs breasts using remaining skin flaps, beneficial for macromastia or high-risk patients.
• Combining this technique with nipple-areolar complex preservation and immediate implant reconstruction is increasing, but risk factors are unclear.

Purpose of the Study:

• To evaluate risk factors influencing nipple viability and tissue expander success in Goldilocks mastectomy reconstructions.
• To identify patient comorbidities and characteristics associated with complications.

Main Methods:

• Retrospective cohort study of 26 patients (41 breasts) undergoing Goldilocks mastectomy by a single surgeon (August 2021-June 2024).
• Procedures included Goldilocks alone, nipple-sparing Goldilocks, Goldilocks with tissue expanders, and nipple-sparing Goldilocks with tissue expanders.
• Data collected on patient demographics, comorbidities, breast measurements, and surgical outcomes, including complications and tissue expander success.

Main Results:

• Overall complication rates: 19.5% major, 9.8% minor. No hematoma or expander exposure.
• Most tissue expander losses (80%) were due to infection or necrosis.
• Diabetes was significantly linked to mastectomy skin flap necrosis (p=0.0092).
• No other comorbidities or breast measurements showed significant association with complications or expander loss.
• Trends toward higher complications were seen in older patients, those with hypertension, and higher BMI, but not statistically significant.

Conclusions:

• Diabetes is a significant risk factor for mastectomy skin flap necrosis in Goldilocks reconstructions.
• Patient selection for nipple-areolar complex-sparing procedures or immediate tissue expander placement should strongly consider diabetes status.
• While other factors like age and BMI showed trends, diabetes emerged as the key modifiable risk factor impacting outcomes.