![]() ![]() 1–3 Many of these patients who undergo mastectomy are interested in postmastectomy breast reconstruction. The rapidly expanding obesogenic environment, culprit of the current obesity pandemic, has considerably increased the number of obese patients, particularly “morbid” (body mass index greater than or equal to 40 kg/m 2) and “super” obese (body mass index ≥50 kg/m 2), requiring postmastectomy breast reconstruction. ![]() For patients with a body mass index of 40 kg/m 2 or greater, the authors recommend the Goldilocks-only procedure or delayed reconstruction. ![]() 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. Patient satisfaction was not statistically different between groups. 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. Overall, 96 breasts underwent the Goldilocks-only procedure and 85 Goldilocks with immediate breast reconstruction. Median follow-up time was 15.1 months (interquartile range, 10.0 to 28.6 months). Mean ± SEM age and body mass index were 57.1 ± 10.4 years and 37.9 ± 5.8 kg/m 2 for the Goldilocks-only group and 51.5 ± 1.1 years and 35.5 ± 0.4 kg/m 2 for the Goldilocks with immediate breast reconstruction group, respectively. One hundred five patients (181 breasts) were included. Patient-reported outcomes using BREAST-Q questionnaires were also assessed. 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. Data were extracted from electronic medical records. Methods:Ī retrospective review was performed of patients with a body mass index of 30 kg/m 2 or higher who underwent the Goldilocks procedure at the Mayo Clinic Health System from 2012 to 2019. 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. Thus, implant-based immediate breast reconstruction in obese women may be controversial. Obesity is a risk factor for complications in breast reconstruction. ![]()
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