Nipple Sparing Goldilocks Mastectomy, A New Modification of the Original Technique

Eur J Breast Health. 2023 Apr 1;19(2):172-176. doi: 10.4274/ejbh.galenos.2023.2023-2-1. eCollection 2023 Apr.


Objective: Although Goldilocks mastectomy offers good aesthetic outcomes. Removal of the nipple-areolar complex (NAC) often has a negative psychological impact. The objective of this study was to assess the feasibility and esthetic outcome of this technique with salvage of the NAC using a dermal pedicle.

Materials and methods: The study included female patients suffering from breast carcinoma with large and or ptotic breast. Patients were offered Goldilocks mastectomy. Those who were unfit for anesthesia, those with locally advanced or metastatic disease or those refusing the procedure were excluded.

Results: Fifteen female patients (18 breasts) with a mean age of 51.6 years underwent Goldilocks breast reconstruction with a trial of NAC preservation. The mean body mass index was 39.1 kg/m2. More than half (56%) were cup C, while 44% were cup D. Seven cases (46.7%) showed grade II ptosis and 8 (53.3%) were grade III. The mean operative time was 168 minutes (range 130-240 minutes). NAC ischemic changes were noted in five cases; two (11%) were partial while three (17%) were total. Two cases (11%) suffered from flap loss and one of them was total. No locoregional recurrence or distant metastases were observed.

Conclusion: The Goldilocks mastectomy with nipple preservation is an appealing and feasible option for a certain group of patients who have large-sized and/or ptotic breasts. Nevertheless, it is a time-consuming technique with relatively higher rates of flap and NAC complications. Further, studies are required with a larger number of cases and longer follow-up.

Keywords: Goldilocks mastectomy; breast reconstruction; nipple areola complex.