The Goldilocks procedure (±Thoraco-Epigastric flaps)

What is the Goldilocks procedure & what does it involve?

The Goldilocks procedure involves a skin-sparing mastectomy (SSM) or a skin & nipple-sparing mastectomy (SNM) where the Oncological Surgeon removes the glandular breast tissue completely, and healthy fatty tissue and skin (the breast envelope) is preserved.

This type of mastectomy and immediate reconstruction differs from a traditional mastectomy in that the remaining healthy breast envelope is used (folded upon itself) to re-create a smaller breast, rather than it being discarded. For cases where this breast envelope is insufficient to create an adequately sized breast or contoured breast, tissue from beneath the original breast (on the thorax) is used to supplement the new breast shape and volume. When this tissue is required, it is called a thoraco-epigastric flap.

Often times, as a delayed or staged procedure, fat transfers can be done to further add to the final contour or appearance of the newly created breast. This is usually done after 4-6 months, once all tissue has settled and final outcome can be appreciated.

Who is a suitable candidate for the Goldilocks procedure?

The Goldilocks procedure is better suited to women with larger or more ptotic breasts who have had a mastectomy and are looking for an alternative to traditional reconstruction such as an implant based or fat/muscle flaps. In these cases, in order to add thoraco-epigastric flaps (tissue from the thorax beneath the original breast) there must be sufficient volume of this donor area.

The procedure must also be warranted from an oncological perspective; the indications and contra-indications of such as surgery, as well as the future expectations will be discussed with you in detail by Dr van den Bergh before considering this surgery.