Case 15 2026: The Goldilocks mastectomy

Keywords: Goldilock, Mastectomy, Goldilocks mastectomy, Breast reconstruction, mamma reconstruction, Oncoplastic, Risk reducing mastectomy, breast cancer, cancer Authors: Nanja Gotland Sundstrup (MD), Pia Cajsa Leth Andersen (MD) Institution: Department of Plastic Surgery and Burns, Rigshospitalet, Copenhagen University Hospital, Denmark Abstract This case report describes the “Goldilocks procedure” as a technique used for primary breast reconstruction in a patient with prior bilateral c. mamma, treated with lumpectomy and radiotherapy. An implant-based reconstruction was not advised due to the radiotherapy, and she was reluctant to undergo larger scale autologous reconstruction. She was suggested the “goldielocks procedure” as an upgrade to the simple mastectomy which was her alternative consideration. the Goldilocks procedure has the advantage of achieving immediate formation of a small breast, while simultaneously establishing a favorable platform for potential delayed reconstruction with autologous fat grafting. Patient medical history The patient, a 67-year-old woman had a history of bilateral breast cancer: left-sided in 2016 and right-sided in 2023, treated with lumpectomy, and radiotherapy, with additional chemotherapy for the right-sided cancer. Further she was found to carry a pathogenic CHEK2 mutation. The patient underwent bilateral risk reducing mastectomy using the Goldilocks technique, with maximal preservation of the skin envelope and subcutaneous tissue (1). Compared with a simple mastectomy, this approach preserved a good shape and projection resulting in the formation of a small breast. Furthermore, the result provided a more favorable foundation for potential delayed breast reconstruction. The patient was planned for a reconstruction in terms of lipofilling, and mastopexy as well as nipple reconstruction. Before and After Patient examination The patient generally presented with good skin quality. Clinical examination revealed sequelae of prior br