Goldilocks mastectomy is a relatively new procedure developed by Dr. Grace Ma and Dr. Heather Richardson. This is a single stage procedure, which gives women facing mastectomy an option that takes the best features of having and not having reconstruction and combining them into a single procedure. This procedure has been a recent topic of debate at many scientific gatherings.
The first question which pops to the mind is that why was this surgery named as Goldilocks mastectomy? The following is the reply given by the surgeons who developed this surgery:
“Most of us are familiar with the story of the young girl faced with uncertainty in the woods and with a big, bad wolf nearby. She had many choices to make, and each time she face a choice, she evaluated the pros and cons; risks and benefits of each one. Most involved extremes -too hot or too cold; too hard or too soft. But there was a third choice that had attributes of both and fell somewhere in the middle. This was considered “just right”.
We chose this name because this technique embodies the simplicity of not having reconstruction and only having a single surgery with as little as possible discomfort and down time. Yet it preserves as much of the patient as possible and avoids an amputated appearance.
For those who still aren’t quite as large as they would like to be and choose to wear a prosthesis, wearing a bra is much more comfortable and the cleavage much more natural appearing. Redundant tissue under the arm is avoided and the final result very soft and supple.
When discussing the different choices and options pre-operatively, it is easy to remember what a “Goldilocks” is and how it differs from mastectomy with and without formal reconstruction.”
Not all patients are eligible for Goldilocks mastectomy. It is mainly suitable for patients with large breasts, who have enough tissue left behind after mastectomy, which can be used to reconstruct the breast. It is NOT suitable for patients with small breasts!!
The following are the advantages of this procedure, as highlighted by the surgeons on the website (www.goldilocksmastectomy.com)
- Can be performed on one or both breasts
- Can be performed for prophylaxis or treatment of disease
- No additional surgeries are required
- No implants or artificial devices are used
- Decreased pain and shorter recovery time when compared to formal breast reconstruction
- Surgical removal of breast gland under the skin means:
- No screening mammograms required
- Most patients do not require radiation (dependent on the stage of disease)
- Excellent option for patients who don’t want reconstruction or are otherwise poor surgical candidates for formal reconstruction
- Patients with extremely large breasts or sagging breasts have the best outcome from this procedure
In this procedure, all the breast tissue is removed and the remaining redundant skin and tissue is mobilized and used to reconstruct the breast, which is usually much smaller than the original size and also in some cases deformed.
As it is a relatively new procedure, long term data is yet to reveal the efficacy and safety of this procedure compared to the conventional mastectomy. Another point which I could gather after reviewing the limited data available on this surgery is that cosmetic results are far INFERIOR than a regular reconstruction (whether implant based or autologous). Another reason for its limited use is that it can only be used in patients with LARGE breasts and a point which has not been highlighted by the authors is the gross disparity in size of the two breasts after the surgery (which is a source of worry to the patient).
It is still early days for this procedure and only time will tell whether it will have a fairy tale ending or not!!
Random Reflections of a Breast Cancer Surgeon 
This appears to be an alternative idea.Problems have already been identified and the procedure seems to be applicable for only limited no of patients.
What do you think about skin & nipple sparing mastectomy ? In my experience of about more than thousand mastectomies more than 90% patients don’t have involvement of nipple and areola.
And in that situation what may be ideal form to give best cosmesis. Prof. Sayeed. Surgical Oncologist, Dhaka, Bangladesh
Thank you for your comments. Goldilocks mastectomy is only meant for patients with large breasts and even then long term follow-up is required to ascertain its efficacy.
We also treat a lot of patients from Bangladesh and the problem is that most of them present in a locally advanced stage. For them the best treatment is NACT, followed by MRM and autologous reconstruction using a DIEP flap. This should be followed by adjuvant chemo, RT and hormonal therapy (depending on the hormone receptor status).