Goldilocks reconstruction is a type of breast reconstruction after mastectomy that uses only the remaining breast skin and subcutaneous fat to create a new breast mound. No breast implants are used, and unlike autologous reconstruction with flaps, there are no additional surgical sites. 

Overview & Why Choose Dr. Chang

Goldilocks Reconstruction

  • Patients Undergoing Mastectomy with Large Breasts Who Want to Be Much Smaller – The Goldilocks reconstruction is only an option for patients with large or very large breasts. Because the breast is reconstructed using just the native breast skin and fat after the breast glandular tissue has been removed, patients have to accept being a much smaller breast size than they were pre-operatively. Because of this reason, patients with small-to-medium sized breasts are not the best candidates.

  • Patients Who Are Not Interested in Implants or Autologous Reconstruction – The Goldilocks reconstruction is a good option for patients interested in breast reconstruction after mastectomy but do not want implants or the donor site sequelae from autologous reconstruction.

  • Patients with Comorbidities Resulting in Unacceptably High Risk of Complications from Implant or Autologous Reconstruction – Certain comorbidities—primarily obesity, diabetes, smoking, autoimmune conditions, vascular disease, and cardiopulmonary disease—significantly increase the risk of surgical complications. Goldilocks reconstruction is one of the lowest-risk types of breast reconstruction and may be the best option for your safety.




Who Is a Candidate?

  • • Medical Evaluation – Dr. Chang will review your medical conditions, medications, prior surgeries, and personal and family history of breast diseases, masses, and cancers. Some patients may be referred to their primary care doctor or a specialist to ensure you are medically optimized for a safe surgery under general anesthesia and post-operative recovery.

  • Breast Examination – Dr. Chang will perform a physical examination of your breasts. This will include measurements of the size, location, and symmetry of the breasts.

  • Clinical Photographs – Clinical photographs from multiple views will be taken of your breasts. These photos are used to plan for your individualized surgery and compare before and after surgery. No photographs will be published online without your written consent.



Pre-Operative

Dr. Chang plans the mastectomy very carefully with your breast surgeon. Dr. Chang saves as much breast skin and subcutaneous fat as possible from an oncological safety standpoint. The remaining breast skin and subcutaneous fat are rearranged and sculpted into an aesthetic breast mound. For nipple-sparing mastectomies, the nipple-areola complex is repositioned to be centered on your new breast mound.






How Goldilocks Reconstruction Is Performed

  • Dressings and Incision Care – Your incisions will be dressed with surgical bandage strips and/or surgical skin glue. You will be wearing a comfortable surgical bra stuffed with gauze pads. The bra should be snug but not overly tight. You should try to wear the surgical bra as much as possible but may remove to shower and to wash the bra. You will have surgical drains. They will be removed at your first post-operative visit. You may shower the day after surgery but cannot bathe or swim until instructed to do so.

  • Pain Management and Medications – Local anesthetic (numbing medication) will be injected at your surgical sites to minimize your immediate post-operative pain. You should take acetaminophen and an NSAID around-the-clock, according to instruction, for the first 72 hours and then as-needed thereafter. You can purchase these over-the-counter. You will be given a small number of low-dose narcotic pain medications for breakthrough pain only for the first 72 hours.

  • Recovery Period – Most patients are admitted for 1-2 days after surgery for pain control. While in the hospital, you are expected to ambulate the same day of surgery. Depending on your occupation, you may return to work 2-4 weeks after surgery. You may resume light cardio exercises at 2 weeks after surgery. You should not lift anything heavier than 5 pounds or extend your arms extensively over your head for the first 2-4 weeks after surgery. You may resume all physical activities at 4-6 weeks after surgery. You should expect some drainage from the incisions and mild bruising around the incisions. You will be swollen, and it can take up to 3-6 months for the swelling to reside. Your incisions will take 2-4 weeks to completely heal, but the final scar will take 6-12 months to mature. Scar care will be discussed at your 1 month post-operative appointment.

  • Follow-Up Visits – If you have any urgent concerns, you may call the office at any time. Otherwise, expect follow-up visits at 1 week, 1 month, 3 months, 6 months, and 1 year.





Post-Operative

  • Asymmetry – No one’s breasts are perfectly symmetric. While the goal is near-perfect symmetry, there may be some asymmetries in breast size or position, nipple-areola complex size or position, and scars.

  • Fat Necrosis – When rearranging your breast skin and fat, the blood supply is maintained as much as possible. If a section of tissue is too badly traumatized or loses too much of its blood supply, it forms a hardened scar. While not dangerous or cancer-predisposing, fat necrosis can be painful and uncomfortable. If large and bothersome enough, the fat necrosis must be removed surgically.

  • Partial or Complete Nipple-Areolar Complex Loss – For nipple-sparing mastectomies, if the blood supply to the nipple-areolar complex is compromised, it may result in partial or complete nipple-areolar complex loss. The risk is higher in patients with very large and/or ptotic breasts. If decreased viability is noticed in the operating room, the nipple-areolar complex may be removed and then sutured back on to survive as a graft. In some cases, the nipple-areola complex will be excised.

  • Unmet Expectations – Despite thorough pre-operative planning and discussions, you still may not be fully happy with your aesthetic results.

  • Poor Scarring – Everyone scars differently. The final scar takes 6-12 months to mature. In rare cases, hypertrophic scars or keloids may form and may require secondary revision.

  • Wound Healing Issues – There may be small areas where the incisions do not fully heal. In these cases, the wounds will be allowed to heal on their own with dressing changes. Severe cases may require a secondary revision procedure.

  • Infection – Infections are managed with antibiotics. In severe cases, you may need an additional procedure.

  • Bleeding – Significant bleeding after surgery may require an urgent return to the operating room. Smaller collections of blood may be treated conservatively or managed with a small procedure in the office or the operative room.

  • Seroma – Fluid collections may develop in the chest. Small ones will be absorbed by the body, but larger ones will need to be aspirated in the clinic.

  • Changes in Sensation – Permanent changes in breast and nipple-areola complex sensation are expected because all the major sensory nerves are cut during a mastectomy. Some sensation often returns between 6-12 months, but you should expect your breasts to feel differently than before surgery.

  • Need for Revision Surgery – For any number of reasons, revision breast reconstruction may be needed to properly achieve your functional and aesthetic goals.

Risks of Goldilocks Reconstruction

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