Total Single-Stage Autologous Breast Reconstruction with Free Nipple Grafts: A Modified Goldilocks Procedure
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Obese patients with significant macromastia and ptosis are poor candidates for traditional implant-based or autologous methods of postmastectomy reconstruction. We have achieved excellent results in this patient population using a recently described technique that allowed for a single-stage autologous reconstruction with free nipple grafts by utilizing the residual mastectomy flap skin and subcutaneous tissue to reconstruct breast mounds. Using this technique, bilateral mastectomy and immediate definitive single-stage reconstruction with free nipple grafts can be completed in 4 h or less depending on breast size. Many patients do not have sufficient residual skin and fat to complete a definitive reconstruction in a single stage and can be supplemented in a second stage with lipofilling or an implant. We describe the technical details and advantages of this new technique and touch on second-stage options in patients who desire additional volume.
I thank my colleague Dr. Piotr Skowronski for his generosity of time and intellectual input that allowed for the development of many of these techniques. I thank my mentors across the world, Dr. Cicero Urban (Curitiba, Brazil), Gustavo Zucca-Matthes (Barretos, Brazil), John Harman (Auckland, New Zealand), Krishna Clough and Claude Nos (Paris, France), Mario Rietjens (Milan, Italy), and Mark Gittos (London, UK) who patiently mentored and taught me the basics of oncoplastic breast surgery.
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