by Bustos, Samyd S.; Nguyen, Minh-Doan; Harless, Christin
A.; Tran, Nho V.; Martinez-Jorge, Jorys; Lin, Jason; Forte, Antonio J.; Casey,
William J. III; Boughey, Judy C.; McLaughlin, Sarah A.; Gray, Richard;
Manrique, Oscar J.
Plastic and Reconstructive Surgery: October 2021
- Volume 148 - Issue 4 - p 703-716
Background:
Obesity is a risk factor for complications in breast
reconstruction. Thus, implant-based immediate breast reconstruction in obese
women may be controversial. The authors analyzed obese patients who underwent
skin-sparing mastectomy using Wise-pattern incisions (Goldilocks procedure) and
compared outcomes between two groups: Goldilocks with immediate breast
reconstruction and Goldilocks only.
Methods:
A retrospective review was performed of patients with a body
mass index of 30 kg/m2 or higher who underwent the Goldilocks procedure at
the Mayo Clinic Health System from 2012 to 2019. Data were extracted from
electronic medical records. Minor complications (partial-thickness wound
dehiscence or flap necrosis, or tissue expander/implant malposition) and major
complications (full-thickness wound dehiscence or flap necrosis, capsular
contracture, tissue expander/implant explantation, or unplanned reoperation or
readmission) were compared between groups. Patient-reported outcomes using
BREAST-Q questionnaires were also assessed.
Results:
One hundred five patients (181 breasts) were included. Mean
± SEM age and body mass index were 57.1 ± 10.4 years and 37.9 ± 5.8 kg/m2 for
the Goldilocks-only group and 51.5 ± 1.1 years and 35.5 ± 0.4 kg/m2 for
the Goldilocks with immediate breast reconstruction group, respectively. Median
follow-up time was 15.1 months (interquartile range, 10.0 to 28.6 months).
Overall, 96 breasts underwent the Goldilocks-only procedure and 85 Goldilocks
with immediate breast reconstruction. Multivariable analyses revealed a higher
rate of minor complications (adjusted hazard ratio, 2.83; 95 percent CI, 1.22
to 7.02) and major complications (adjusted hazard ratio, 2.26; 95 percent CI,
1.25 to 4.24) in the Goldilocks with immediate breast reconstruction group
compared with the Goldilocks-only group, at any given time. Patient
satisfaction was not statistically different between groups.
Conclusions:
The Goldilocks procedure is a feasible breast reconstructive
option in obese patients; however, when it is performed with immediate breast
reconstruction, it is associated with higher rates of complications. For
patients with a body mass index of 40 kg/m2 or greater, the authors
recommend the Goldilocks-only procedure or delayed reconstruction.
