Evaluating the Goldilocks Technique for Breast Reconstruction in High-BMI Patients: A Systematic Review of Complications and Patient Satisfaction
Sebastian Kiehn, Alexander Chang, Gabrielle Knauer, Natalia Mejia, Sarah Bauman, Sai Mandalapu, Sameer A. Patel, Adam WalchakIntroduction
The Goldilocks procedure, first described in 2012, is a reconstructive option for post-mastectomy patients who are poor candidates for traditional reconstruction. It is most commonly used in obese patients with macromastia, a population known to have higher complication rates with standard techniques. This study systematically reviews the literature to evaluate complication rates, aesthetic outcomes, and oncologic safety of the Goldilocks approach.
Methods
A systematic review was performed using PubMed, ScienceDirect, and Google Scholar. Studies reporting complications of the Goldilocks technique were screened by two independent reviewers for relevance and underwent full-text analysis.
Results
Of 58 articles screened, 13 met inclusion criteria. A total of 370 patients underwent 550 Goldilocks reconstructions. Mean BMI was 37.1 and mean age was 57.3 years. Reported complications per reconstructed breast included wound dehiscence (5.27%), fat necrosis (3.82%), seroma (4.36%), wound necrosis (4.36%), infection (3.82%), and hematoma (2.18%). Surveyed patients were satisfied with 92.4% of surgeries performed. The one study exploring oncologic safety showed no need for increased cancer screening.
Conclusion
These findings demonstrate that the Goldilocks procedure is a valuable option for obese and high-risk patients, with complication rates lower than traditional techniques in similar populations. While aesthetic outcomes are limited by breast size, patient satisfaction remains high with careful patient selection. This technique also serves as a bridge to delayed reconstruction, including fat grafting, implants, or autologous flaps. These findings should improve physicians’ ability to counsel patients regarding the potential outcomes and limitations of this procedure.