Oncological and Surgical Outcomes of Goldilocks Mastectomy at a Tertiary Public Hospital in Johannesburg, South Africa

Abstract

Background: Breast cancer remains a significant health burden, particularly in South Africa, with rising prevalence and challenges in access to reconstructive surgery for affected women. The Goldilocks Mastectomy, introduced as a minimally invasive reconstructive procedure following mastectomy, offers a potential solution to address cosmetic and psychological concerns in patients with limited access to formal reconstruction. This study evaluates the oncological adequacy and clinical outcomes of the Goldilocks Mastectomy in a South African cohort, focusing on factors influencing postoperative complications. Methods: A retrospective review was conducted at Helen Joseph Hospital (2017– 2024) on 50 patients (95 breasts) undergoing Goldilocks Mastectomy. Data included demographics, comorbidities, surgical complications (graded by Clavien-Dindo classification), and histopathological margin status. Logistic regression models identified predictors of complications. Results: The mean age was 45 years (interquartile range [IQR] 39–53), with a mean Body mass index (BMI) of 28.5 (IQR 26.0–35.3). Complications occurred in 20% (n=10), including haematoma (20%), nipple necrosis (20%), and wound dehiscence (10%). Reoperation rate was 14% (n=7). Positive margins were observed in 12% (n=6), with two requiring re-excision. Increased weight (odds ration [OR] 1.09, 95% confidence interval [CI] 1.02–1.21, p=0.036) and positive margins (OR 67.6, 95% CI 4.44–3690, p=0.009) were significant predictors of complications. Conclusion: Goldilocks Mastectomy demonstrates acceptable oncological safety and complication rates in carefully selected patients. It expands excess to reconstruction in both the obese and comorbid population. Furthermore, the simplicity and use of native tissue makes the Goldilocks Mastectomy inherently more cost effective when compared to flap or implant-based reconstruction. A significant advantage in low- resource environments.