Finding the Perfect Fit: The Goldilocks Mastectomy

When faced with a breast cancer diagnosis, the journey towards recovery can be overwhelming. One of the most important decisions a patient must make is choosing the right treatment option.

In recent years, Dr. Schwartz has been offering and perfecting for his patients a revolutionary approach known as the Goldilocks mastectomy. This personalized procedure, pioneered by two surgeons, one of whom was his fellow surgical resident at Emory, offers breast cancer patients a unique and tailored experience. In this article, we will delve into the Goldilocks mastectomy, its benefits, its impact on breast cancer treatment, and why it has become a game-changer for breast cancer patients at his clinic.

Understanding the Goldilocks Mastectomy

Traditional post-mastectomy reconstruction can be a daunting prospect for many women. The idea of placing a foreign object, such as an implant, inside their bodies raises concerns about potential complications and long-term health risks. Women’s concerns with mammogram visibility and reports of cancers that result from using certain types of implants. Worth mentioning is a more recent phenomenon of breast implant illness (BII) with its debilitating symptoms (fibromyalgia, fatigue, brain fog, autoimmune disease, etc. that may or may not be associated with implant reconstruction), which have further fueled these anxieties. There are other complications associated with implants including infections, capsular contracture, rupture, and likely need for additional surgeries in the future that discourage women from pursuing this route.

Additionally, flap reconstructions, while effective, involve lengthy surgeries that require incisions in other parts of the body (the back, the belly, the thighs) and extended recovery times. It’s also quite rare that a patient would require just one surgery for a flap reconstruction as most patients undergo future revision for symmetry and perfecting the reconstructed breast. With these factors in mind, a new option has emerged – the Goldilocks mastectomy.

The Goldilocks mastectomy, also known as the oncoplastic mastectomy, combines the principles of oncology and plastic surgery to achieve the best possible outcome for breast cancer patients. This procedure offers women an alternative between traditional reconstruction methods and forgoing reconstruction altogether. This innovative approach provides a middle ground that addresses both the desire for a reconstructed breast and the concerns associated with implants and flap reconstructions.

The Goldilocks mastectomy is named after the famous fairytale character who searched for the perfect fit. Similarly, this procedure aims to provide breast cancer patients with a treatment plan that is just right for their individual needs. Dr. Schwartz, a leading expert in the field, recognized that every patient’s journey is unique and should be treated as such, delivering the “just right” level of tailored care.

This innovative approach considers various factors, including the patient’s age, breast size and shape, tumor characteristics, and personal preferences. By incorporating these aspects, the Goldilocks mastectomy ensures that the patient receives a personalized treatment plan that optimizes both cosmetic outcomes and long-term health.

Goldilocks Mastectomy the Game-changer for Optimal Outcomes

During the Goldilocks mastectomy, which is performed at the time of the mastectomy, a small breast mound is created. Now about 10 years ago, Dr. Schwartz realized that this approach was a really good option for high-risk patients, women with large natural breasts, and women with elevated body mass indexes (BMI) and some degree of breast droop, known as ptosis. Ptosis provides the necessary excess skin to create a small breast mound. In the past, these women faced significant challenges with traditional reconstruction methods, experiencing high rates of implant loss and wound healing complications. Many of these women were refused reconstruction by plastic surgeons and the Goldilocks mastectomy gave them something that set them up for an easy second surgery to complete reconstruction in a safe fashion. Women who were refused immediate reconstruction and underwent mastectomy typically lost much of their breast skin which made future reconstructions challenging, requiring multiple operations with poor aesthetic outcomes.

While this approach falls short of full reconstruction, these women are satisfied with their results, and it eliminates their need for additional surgeries and avoids “going flat”. In fact, some techniques now allow for the preservation or reattachment of the nipple, enhancing the aesthetic outcomes of the procedure.

One of the key features of the Goldilocks mastectomy is its personalized approach. Therefore, it is important to note that by offering a first-stage Goldilocks mastectomy, surgeons can safely bridge these patients to a more definitive reconstruction if they decide they want to pursue options like implant placement, fat transfer, flap reconstruction, or even Dr. Schwartz’s latest invention and improvement of the Goldilocks mastectomy – a reverse abdominoplasty (tummy tuck) after they have completed their oncological treatment including chemotherapy and radiation therapy. This flexibility ensures that the patients’ oncological care remains the top priority while still allowing for safe and effective reconstructive surgeries to be performed at the patient’s convenience, months or even years after the initial operation.

Achieving Balance: The Benefits of the Goldilocks Mastectomy

The surgery itself is relatively quick, typically taking less than three hours for bilateral mastectomy and Goldilocks reconstruction, and recovery is similar to that of a traditional mastectomy. The incisions made during the procedure resemble those of a breast reduction.

What are the benefits of Goldilocks mastectomy that women are looking for?

  1. Improved Cosmetic Results

The Goldilocks mastectomy focuses on preserving the natural shape and contour of the breast. By utilizing oncoplastic techniques, surgeons can remove the cancerous tissue while reshaping the breast to achieve a balanced and aesthetically pleasing outcome. This approach significantly reduces the emotional impact of losing one or both breasts, aiding in the patient’s overall self-confidence and body image.

  1. Reduced Post-Operative Complications

Traditional mastectomy procedures can sometimes lead to complications such as wound healing problems, infections, and seromas. The Goldilocks mastectomy, with its focus on precision and personalized treatment, minimizes the risk of these complications. By optimizing the surgical technique based on individual patient characteristics, the Goldilocks mastectomy enhances the healing process and reduces the likelihood of post-operative complications.

  1. Enhanced Psychological Well-being

Breast cancer can take a toll on a patient’s mental health. The Goldilocks mastectomy acknowledges the psychological impact of breast cancer treatment and aims to minimize the emotional burden. By providing patients with a sense of control and involvement in their treatment decisions, this approach empowers them and supports their emotional well-being throughout the recovery process.

Innovation Meets Collaboration: The Multidisciplinary Approach

The Goldilocks mastectomy is a testament to the power of expertise and collaboration between oncology and plastic surgery. This multidisciplinary approach ensures that patients receive the highest level of care and expertise throughout their journey. As a leading oncoplastic surgeon (a surgeon who combines breast cancer tumor removal and reconstructive plastic surgery techniques at the time of breast conservation surgery), Dr. Schwartz is constantly improving Goldilocks mastectomy to please the personal needs of his patients. One of the most exciting developments he is currently working on is the use of a reverse tummy tuck (abdominoplasty) in a second surgery to supplement a first-stage Goldilocks mastectomy.

Pre-Goldilocks mastectomy

Pre-reverse tummy tuck

Final result

This procedure can often supply each breast with 300-500 ml of their own tissue and can give many patients a definitive reconstruction without using an implant or making incisions in other parts of their body.

Reverse tummy tuck is an outpatient surgical procedure that takes Dr. Schwartz about two hours and the recovery time is just a few weeks.


The Goldilocks mastectomy represents a significant advancement in breast cancer treatment, allowing for a personalized approach that prioritizes both the medical and aesthetic needs of patients. By achieving a balance between the removal of cancerous tissue and the preservation of the breast’s aesthetic appearance, this technique offers improved cosmetic results, reduced post-operative complications, and enhanced psychological well-being. This provides women with more choices and improved outcomes. By offering a safe, flexible, and effective alternative, this procedure empowers women to make informed decisions about their bodies and their health.

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