GOLDILOCKS MASTECTOMY

WHAT IS A GOLDILOCKS MASTECTOMY?

Goldilocks procedure is undertaken subsequent to a mastectomy, aimed at eliminating unhealthy breast tissue. Following the mastectomy, the remaining fatty tissue and skin undergo a transformative process to craft a breast mound, thereby providing some semblance of shape and definition to the breast. While this procedure is commonly employed for patients with larger and heavier breasts, its applicability extends to some patients with smaller breasts. The Goldilocks mastectomy, therefore, offers a flexible and patient-centered approach to breast reconstruction.

WHEN WAS IT FIRST DESCRIBED? 

Described by Richardson and Ma in 2012, it utilises the redundant inferior mastectomy flap tissue for breast mound construction. After a skin-sparing mastectomy, the de-epithelialized mastectomy flap within the Wise pattern incision boundary is shaped to create breast volume.

WHY IS IT CALLED GOLDILOCKS? 

The name "Goldilocks" is fittingly chosen as it signifies a 'middle-of-the-road' option for patients; an option that isn't too extreme one way or the other. It sits comfortably halfway between mastectomy with a flat-closure and full reconstruction with expanders, implants or a body wall flap procedure. This moderate alternative offers patients a balance, avoiding the extremes associated with a completely flat-chested appearance or the comprehensive reconstruction involving implants or flaps.

WHAT IS THE ADVANTAGE OF A GOLDILOCKS MASTECTOMY?

It can prevent potential complications associated with implant reconstruction, without impacting other areas of the body as autologous reconstruction. Excellent option for women who either cannot undergo or choose not to pursue immediate reconstruction following a mastectomy. Also used in patients with other medical comorbidities who may not be good candidates for immediate breast reconstruction because of the potential complications. It can be a standalone procedure, offering a viable solution for those who may not desire or be suitable for further reconstruction immediately. Moreover, it can act as a foundational step, providing a template or canvas for potential future breast reconstruction if desired.

WHAT ARE THE DISADVANTAGEs?

Uncertainty regarding the final size of the breast mound. Complications related to wound healing, particularly at the juncture of breast scars (referred to as the 'T-junction'), may arise, necessitating the use of dressings for an extended duration.

WHAT is the planning steps for this sort of MASTECTOMY?

Weigh considerations and have comprehensive discussions with healthcare team to make informed decisions about the most suitable surgical approach for individual circumstances.

Collaboration among various healthcare professionals is crucial for the success of the Goldilocks operation. Importance of a team approach, involving surgeons,  assistants, and nursing staff. Patient education before surgery, coordination of the operation, and providing support throughout the recovery process.

Close working relationship and regular meetings to discuss treatment options contribute to individualised recommendations based on factors such as patient staging, tumour characteristics, and desired surgical outcomes.