Goldilocks Reconstruction

Traditionally Goldilocks Reconstruction was used to describe a type of reconstruction where the skin and fat left after a mastectomy was rearranged in such a way to create a breast. The tissue from the lateral breast and chest wall can also be recruited to provide additional volume. This technique works well in women with large breasts who want smaller breasts postoperatively and fits the adage of “not too big, not too small, but just right” from the Goldilocks and Three Bears story. Now, there are multiple applications of Goldilocks Reconstruction:

  • The reconstruction can be performed in the traditional aspect, rearranging the patient’s own tissues to create a new, smaller breast. If desired, the patient can undergo one or more episodes of fat grafting to enhance the size or shape of the breast.
  • The reconstruction can be performed in combination with a tissue expander and/or implant for women with large, droopy breasts desiring better breast shape with a more youthful and “perky” appearance.
  • The reconstruction can be performed in patients who do not want reconstruction but want to limit or prevent the concavity that can be caused by a mastectomy.

If you are a candidate for a nipple-sparing mastectomy, there is a chance that the nipple areola complex can be salvaged with Goldilocks Reconstruction. The ability to preserve the nipple is unpredictable; the nipple receives much of the blood supply from feeding blood vessels that travel through the breast tissue which is removed during the mastectomy. Hence, the nipple is only receiving a fraction of the blood supply it once did. The ability to save the nipple is an intra-operative decision and the various options on how to proceed if it is not able to be saved can be discussed with Dr. Elswick pre-operatively.

The incision is in the form of an upside down “T” with a horizontal scar in the fold under the breast. If your nipple-areola complex is preserved, there will also be a scar around the areola.

Once the mastectomy is complete, Dr. Elswick will rearrange the remaining tissue to create the best shape possible. Some of the extra skin and fat on the lower part of the breast gets buried under the upper skin and fat. This is done through a process called de-epitheliazation where the most superficial part of the skin is removed so it can be buried in the breast cavity. One to two drains are placed on each side of the mastectomy, depending on whether or not you have a lymph node dissection.

The surgery usually takes 1.5-2 hours depending on whether you are having single or double mastectomies. This time is in addition to the time it takes to complete the mastectomy. Patients are usually hospitalized for one night after a mastectomy with Goldilocks Reconstruction.