Goldilocks Mastectomy and Reconstruction

Who is a good candidate?

The best candidates for this approach are patients who have significant excess skin and ptosis (nipple and skin are located far below breast crease). Obese patients are also good candidates because they have significant excess fat in their breasts than can be used to reconstruct the breast.  Most patients, however, end up with results that fall short of a complete reconstruction but can elect for a second surgery to add volume with an implant or their own tissues.  Dr. Schwartz has published extensively on this strategy as well.  If you are interested in a definitive reconstruction and are not high risk for complications (obesity, smoking, diabetes), Dr. Schwartz will recommend immediate addition of an implant or flap at the time of your Goldilocks surgery.  If you are high risk, he will likely recommend implant or flap placement in a second surgery to minimize complications.

Consultation and Procedure

During your consultation, Dr. Schwartz will evaluate your individual case and formulate a treatment plan that is right for you. Thanks to Dr. Schwartz’s access to a private Outpatient Surgery Center, patients who undergo bilateral Goldilocks Mastectomy are scheduled without a delay.  Goldilocks Mastectomy is always covered by health insurance companies and this coverage is guaranteed under federal law. 

Dr. Schwartz typically completes a unilateral Goldilocks surgery in 75 minutes and bilateral surgery in 2.5 hours under general anesthesia.  Typically, one drain is placed into each breast unless a significant lymph node dissection is performed (for more advanced cancers) when 2 drains will be placed.  Patients are discharged home on the day of surgery. Dressings are placed in the operating room which stay on until the following week when they are removed, and a sports bra is put on.

The scars of Goldilocks Mastectomy are identical to breast reduction surgery- around the areola, straight down to the breast crease and then in the breast crease- “anchor incision”.   Dr. Schwarz almost always makes an effort to reconstruct or save the nipple at the time of Goldilocks Mastectomy.   Some patients will elect to have an implant or flap placed at the time of Goldilocks surgery.  Dr. Schwartz has published on this approach.  This will obviously lengthen the procedure and recovery time.  Placing an implant during Goldilocks surgery will lengthen the procedure by approximately 20 minutes per side, while flap placement will add 2.5 hours per side.

Recovery and Results

Recovery times after Goldilocks Mastectomy vary depending on the individual breast size and whether unilateral or bilateral surgery is performed.   Recovery is typically two to three weeks and patients can expect to return to their normal activities and exercise within four weeks. Drains are left in place for 10-14 days.  Patients are placed in a sports bra at their first post-operative visit and should wear this for three months.   Most patients will have a reconstructive result that will fall short of a definitive reconstruction (with respect to size) and some patients will choose to improve their aesthetic result with fat transfer, implant placement of flap reconstruction 3-6 months after their initial surgery.  Results from Goldilocks mastectomy surgery are very good and are far superior to a traditional mastectomy where a straight line is places across the chest (breast amputation).

Your surgical or sports bra will need to be worn for 12 weeks following your surgery.  You should plan to be off work for 3-4 weeks, depending on the type of work you perform.   You also may feel pulling or stretching in your breast area. Although you may need pain medicine for a week or two, you can expect to feel better and stronger each day. For several weeks, you may get tired easily or have less energy than usual. You also may have the feeling that fluid is moving in your breasts. This feeling is normal and will go away over time.

Goldilocks Mastectomy results in significant changes in sensation, with most losing significant nipple sensation permanently.  Over time, much of the breast skin will regain normal sensation.    Keep in mind that it may take time to get used to your new breasts. You will have swelling at first. But the breasts will soften and appear more natural over time. You are likely to feel well enough to return to work after 2 to 4 weeks, based on your progress. You can usually resume normal physical activities in this time frame as well.   You should expect some scarring following Goldilocks Mastectomy; however, these scars will gradually fade over time.