Goldilocks procedure

With a Goldilocks procedure, a plastic surgeon removes the breast tissue and preserves breast skin and fat to create a breast mound, all in one operation. The Goldilocks procedure builds a new breast without using implants or tissue from other parts of the body (a donor site).

This procedure is also called a Goldilocks mastectomy. The Goldilocks name suggests a middle ground—or “just right”—surgery because it does not require donor tissue or implants.

Not everyone is a candidate for this kind of reconstruction, and the size and shape of the reconstructed breast can be different from person to person.

On this page, you will find information about how the Goldilocks procedure works, who can get this procedure, recovery, and the benefits and risks.

How the Goldilocks procedure works

To understand how a Goldilocks procedure works, it helps to learn about the different tissues inside the breast. Breast tissue consists of milk ducts, lobules, and connective tissue. Fatty tissue surrounds the breast tissue.

During a Goldilocks mastectomy, a breast surgeon and plastic surgeon will work together to remove the breast tissue and preserve the fatty tissue and some skin.

• First, the breast surgeon removes the breast tissue.
• Right after the breast tissue is removed, but during the same procedure, the plastic surgeon uses the preserved fatty tissue and healthy skin to create a new breast mound. This can include fatty tissue under the breast skin as well as fatty tissue on the side of the chest or under the breast.

“When performing a mastectomy, the goal is to remove all of the breast tissue, which includes all of the cancerous and at-risk tissue,” says Sameer A. Patel, MD, FACS. “It is important that the Goldilocks procedure not compromise the quality of your mastectomy.”

Dr. Patel, chief of plastic and reconstructive surgery at Lewis Katz School of Medicine/Temple University Hospital and Fox Chase Cancer Center in Philadelphia and member of the LBBC Medical Advisory Board, says that’s why it’s important for a woman considering a Goldilocks mastectomy to confirm with her surgeon that all of the breast tissue will be removed during surgery.

Goldilocks procedure and risk of recurrence

The Goldilocks procedure was developed in 2012. This means the procedure is still fairly new, and doctors need more long-term data to know more about the risk of recurrence.

Still, if all of the breast tissue is removed, the risk of breast cancer recurrence is similar to the risk of recurrence after any other mastectomy. This is why it’s important to confirm with your doctor that all of the breast tissue is removed.

Does the Goldilocks procedure allow you to keep your nipple?

Goldilocks can allow some women to keep their nipples. If there is enough blood supply to the nipple after the breast tissue is removed, the plastic surgeon can preserve the nipple. If not, the plastic surgeon may remove the nipple and then graft it onto the new breast mound.

If the nipple is removed during the Goldilocks procedure, nipple reconstruction surgery or 3D nipple tattooing can usually be done a few months later.

Who can get the Goldilocks procedure?

The Goldilocks procedure can be an option for people who:

• Have large breasts or breasts that droop because there is enough tissue and skin that can be used to recreate a breast or breasts
• Are non-smokers (smoking can narrow blood vessels and interfere with blood flow to the new breast). Smokers who have this procedure may have more complications than non-smokers.

Timing of Goldilocks with radiation therapy

If radiation therapy is part of your treatment plan, talk with your breast surgeon and plastic surgeon about the impacts of radiation on your result. “Radiation can alter the shape and appearance of the breast after any type of reconstruction surgery,” says Dr. Patel.

Recovering from the Goldilocks procedure

Recovering from a Goldilocks procedure takes about 4 weeks from the time you leave the hospital.

For more information about recovery, visit our Recovering from breast cancer surgery page.

Benefits and risks

Here are the benefits of the Goldilocks procedure:

• This procedure removes cancerous tissue and creates a new breast in a single operation.
• Because the Goldilocks procedure doesn’t require implants, it avoids risks associated with implants.
• Because this procedure doesn’t use donor tissue from another part of the body, there are no wounds or scarring at another site on the body.
• For people who’ve wanted a breast reduction, this procedure can achieve that.

Risks of Goldilocks procedure include the following:

• While doctors believe the risk of recurrence after Goldilocks is low, recurrence rates are still uncertain because the procedure is fairly new. To understand risk, researchers need more data after a longer time. However, early research shows that recurrence rates after a Goldilocks procedure are about the same as with other types of breast reconstruction.
• Breast projection (how far a breast sticks out from the chest) may not be as good as with other kinds of breast reconstruction.
• Possible side effects include:
  • Skin necrosis: skin cells dying due to lack of blood supply)
  • Seroma: a lump filled with clear fluid)
  • Hematoma: a buildup of blood
  • Infection

These can be resolved with surgical or non-surgical procedures. Ask your care team about the risks of these side effects and how they are treated if they happen.