A balance between breast reconstruction and amputation, Goldilock mastectomy

Background. Goldilocks mastectomy is an innovative surgical technique developed for patients with breast cancer who are looking for a balance between oncologically safe tumor removal and an optimal final aesthetic result.Aim. To perform an optimal type of reconstruction in overweight patients with serious comorbidities who have abandoned the standard options for restoring the shape of the breast by preserving a de-epidermized lower flap during mastectomy.Materials and methods. This study included 22 patients (31 Goldilocks mastectomy) aged 31 to 75 years diagnosed with breast cancer who received treatment from June 2023 to November 2024 at the N.N. Petrov Research Institute of Oncology. The average body mass index was 29.69 ± 3.92 kg/m2. Obesity was diagnosed in 86.4 % (19/22) of cases. All patients had 2 or 3 degrees of mammary gland ptosis.Results. In 59.1 % (13/22) of cases patients underwent unilateral Goldilocks mastectomies, in 40.9 % (9/22) – bilateral operations using this technique. In 16 patients (72.7 %) the nipple-areolar complex was preserved. The overall complication rate was 12.9 % (4/31). The patients noted that the final subjective perception of the treatment results exceeded the expectations of the performed surgical intervention.Conclusion. Breast reconstruction in overweight patients can be performed in various ways. Based on the experience of the N.N. Petrov Research Institute of Oncology and the results of this study, Goldilocks mastectomy is the best reconstruction option for patients with high body mass index or ptosis of the mammary glands, as well as concomitant diseases. This technique allows the surgeon to remove breast tissue within the anterior and posterior leaves of the superficial fascia, create additional volume using a de-epidermized flap, which preserves oncological safety and improves the aesthetic result.