SP58. Risk Factors Influencing Tissue Expander Loss and Nipple-areolar Complex Preservation in Autologous Reconstruction Following Goldilocks Mastectomy

PURPOSE: The Goldilocks mastectomy offers a unique reconstructive option by utilizing the residual mastectomy flap to recreate an autologous breast mound. This technique decreases the total cost and number of procedures while creating a more aesthetic option than simple mastectomy. The current literature advocates for use of this procedure in patients with higher-than-average risk factors that are poor candidates for more extensive reconstructive techniques. However, the current literature is lacking a comprehensive analysis of the risk factors that dictate nipple preservation and tissue expander-related complications when performed in conjunction with the Goldilocks technique. Consequently, the purpose of this study is to characterize the risk factors that impact patient outcomes in this setting. We expect to see increased complications in patients with higher BMIs and ptotic breasts. METHODS: This is a single-institution retrospective cohort study following patients who underwent Goldilocks reconstruction between August 2021 and June 2024. Adult patients were included if they had a diagnosis of breast cancer and underwent unilateral or bilateral goldilocks mastectomy. The main variables include tissue expander loss and unplanned OR return. Data was analyzed with Graph Pad Prism. RESULTS: 27 patients (42 breasts) were included. Of these, 13 breasts underwent Goldilocks alone, 11 breasts underwent nipple-areolar complex (NAC) sparing Goldilocks, 8 breasts underwent Goldilocks with immediate tissue expander placement, and 10 breasts underwent Goldilocks with NAC sparing and immediate tissue expander placement. Pertinent risk factors associated with readmission, unplanned OR return and postoperative complications in combined NAC sparing and immediate tissue expander placement include BMI above 30 and ptotic breasts (grade 2-3), although this was not statistically significant (p-value = 0.158). Notably, 11 breasts underwent staged autologous reconstruction with an initial goldilocks procedure followed by either LICAP or DIEP flaps. In 36% (4 breasts) of these, DIEP flaps were used to salvage the reconstruction following tissue expander infection and/or nipple necrosis. CONCLUSION: Given the increasing prevalence of breast cancer, obesity and other chronic comorbidities, further research on this topic is key to identify ideal candidates for Goldilocks reconstruction. Additionally, an algorithm for staged pure autologous reconstruction will be described at our institution utilizing the Goldilocks procedure as a bridge for patients with higher-than-average risk factors who desire an aesthetic, nipple-sparing reconstructive option. This stepwise approach provides an aesthetic outcome that is improved from the pre-cancer state and is beneficial for the breast surgeons due to the efficiency of and better exposure during the initial Goldilocks procedure.