You remember Goldilocks.
She tried the beds of The Three Bears, finding one to be too soft, one too hard, and finally, one that was just right. Now, a new type of mastectomy is named for her.
The Goldilocks mastectomy was developed in 2011 by breast surgeon Dr. Heather Richardson and plastic surgeon Dr. Grace Ma. The procedure is a middle-of-the-road approach to mastectomy and breast reconstruction: patients aren’t flat or reconstructed after mastectomy. Instead, they have a small breast mound. The analogy may be a bit of a stretch, but rather than being “too flat” (traditional mastectomy) or “too complex/involved” (breast reconstruction), surgical Goldilocks is meant to be “just right” for obese women with large, ptotic (drooping) breasts who don’t want to be flat after mastectomy but don’t want or can’t have breast reconstruction.
The Goldilocks procedure begins with a traditional skin-sparing mastectomy incision: a circular or elliptical mastectomy incision is made around the nipple and areola, through which all visible breast tissue is removed. A Wise-pattern incision, which is often used in breast reduction, is then made, and the skin inside the outline is removed. The layer of fat just beneath the breast skin that is normally removed and discarded during mastectomy is then rearranged into a small breast mound. The incision edges are then pulled together and sutured in place. Goldilocks works best for women who have large, pendulous breasts because they have more fat to sculpt into a breast mound once breast tissue is removed.
The nipple and areola are removed or treated as a free nipple graft (the nipple is removed from the breast and then relocated on the remaining post-mastectomy breast mound. If a unilateral Goldilocks mastectomy is performed, the opposite breast can be reduced for better symmetry.
If you're dissatisfied with your results, your new breast mound can be subsequently improved with fat grafting. Reconstruction with a breast implant or tissue flap is also an option for women who are willing to undergo further procedures and recovery.
Two other important factors
The Goldilocks mastectomy hasn’t been used long enough to determine whether it is oncologically safe or whether it affects recurrence.
And obesity doesn’t automatically preclude women from having immediate or delayed breast reconstruction. Nevertheless, obese women are often told that their excessive weight precludes them from being candidates for reconstruction. In fact, studies show that obese women are as likely to be satisfied with the results of reconstruction as thinner women, but they do tend to have more post-op issues, including infection and delayed wound healing, and they often need longer hospital stays. Having an experienced reconstructive surgeon, especially one who exclusively and routinely performs reconstruction with obese patients, is advised.