Dermal Sling Research Articles

Management of Breast Cancer by Skin-Reducing Mastectomy and Immediate Breast Reconstruction by Prepectoral Implant Approach with Polypropylene Mesh for Patients with Large Breasts.

To assess the feasibility and outcomes of immediate breast reconstruction using a dermal sling and polypropylene mesh for fixation after skin-reducing mastectomy with prepectoral prosthesis placement in patients with large breasts who were diagnosed with cancer. This retrospective study included demographic and clinical data from female patients with breast cancer and large breasts, who were candidates for skin-reducing mastectomy and immediate reconstruction. Data regarding operative technique, implant size, operative duration, and intraoperative complications were retrieved. Early and late postoperative complications were recorded. Routine assessment of postoperative patient satisfaction was performed using the Breast Reconstruction Satisfaction Questionnaire. The study included data from 49 female patients with a mean (± SD) age of 40.88 ± 8.03 years; the mean follow-up was 31.5 ± 8.1 months. The operation was successful in 47 (95.9%) patients, whereas reconstruction failed in 2. Capsule contracture occurred in 9 (18.4%) patients, 4 of whom required capsulectomy. Severe wound infections occurred in 2 (4.1%) patients, 1 of whom was treated conservatively. Implant exposure occurred in 2 (4.1%) patients, 1 of which was managed using a skin rotational flap. Five (10.2%) patients experienced mildly impaired range of motion. Forty-four (90.0%) patients reported postoperative satisfaction, with 3 expressing satisfaction only when postoperative complications were treated. The prepectoral approach using a combined synthetic mesh and dermal sling yielded a good solution for patients with large breasts. The technique was associated with minimal complications, yielded good postoperative patient satisfaction, and is affordable. The results of using a synthetic mesh appeared to be equivalent to those of ADM. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Meshed Dermal Sling for Prepectoral Breast Reconstruction.

The best breast reconstruction solution after mastectomy remains a topic of wide debate. Recently, the focus in the field of implant-based reconstruction has been on the increasing indications for prepectoral reconstruction. This offers undoubted advantages over subpectoral reconstruction, ranging from better aesthetic results and patient comfort to a less invasive procedure that spares the pectoralis major muscle, reducing pain and postoperative recovery time. The dermal sling is a reconstructive variant introduced by Bostwick in the 1990s and is commonly used to complete the subpectoral pocket in one- or two-stage reconstruction, creating a dual-plane reconstruction. This method may be indicated after mastectomy for both therapeutic and prophylactic purposes. It can also be used for unilateral and bilateral reconstructions. We propose a new meshed dermal sling technique that allows complete prepectoral reconstruction without the use of acellular dermal matrix, thus reducing the cost of reconstruction. It also allows the indication for complete prepectoral reconstruction to be extended to patients with medium breast volume and grade 1 or 2 ptosis, without the need to use acellular dermal matrix or the pectoralis major muscle to complete the breast pocket.

Wise-Pattern Mastectomy with an Inferior Dermal Sling: A Viable Alternative to Elliptical Mastectomy in Prosthetic-Based Breast Reconstruction.

Prosthetic-based postmastectomy breast reconstruction in patients with large or pendulous breasts remains challenging because of inelastic and redundant skin, with various approaches to skin reduction at the time of mastectomy. This study describes the authors' experience with a Wise-pattern inferior dermal sling approach to skin-sparing mastectomy. Retrospective chart review was performed on patients who underwent immediate prosthetic-based breast reconstruction after mastectomy from 2009 to 2021. A total of 240 patients who underwent Wise-pattern skin-sparing mastectomy (WSSM) were compared with a cohort of patients who had traditional elliptical skin-sparing mastectomy (ESSM), matched for mastectomy weight, prior radiation therapy, and smoking. Ninety-day postsurgical outcomes were examined. The WSSM cohort had a significantly higher body mass index (30.3 kg/m 2 versus 26.9 kg/m 2 ; P < 0.0001) and mastectomy weight (831 g versus 607 g; P < 0.0001). After propensity score matching, there was no significant difference in complication or treatment rates between WSSM and ESSM breasts except for mastectomy flap necrosis (11.6% versus 5.0%; P = 0.0082). WSSM patients who had mastectomy flap necrosis did not have significantly different treatment rates of admission, return to the operating room, or explantation compared with ESSM patients. In the largest reported series to date, WSSM was associated with a higher rate of mastectomy flap necrosis, but this did not translate into statistically significant differences in treatment. The inferior dermal flap likely acts as a protective layer of vascularized tissue, which appears to prevent evolution of mastectomy skin flap necrosis into more serious adverse outcomes. Therapeutic, III.

Extended dermal sling for implant-based immediate prepectoral breast reconstruction in large ptotic breasts without using a mesh in early breast cancer

Background The rate of immediate breast reconstruction after mastectomy for early breast cancer has recently increased owing to the technological advancements in tissue expanders and implant designs, acellular dermal matrices, and fat grafting. The use of an extended dermal sling to cover the implant in patients with large ptotic breast allows prepectoral breast reconstruction, avoiding the complications and pitfalls of pectoralis muscle elevation and evading the use of the acellular dermal matrices with its high cost and being a foreign material. Patients and methods A total of 22 patients underwent mastectomy through a Wise pattern incision. The de-epithelialized extended dermal sling was used to create a prepectoral pocket for the implant and sutured to the pectoralis fascia. Results The median BMI was 31.5 kg/m2 (range, 28–39). The median distance between the areola and the inframammary fold was 20.3 cm (range, 18–26). A total of 13 patients had permanent implant and nipple graft, whereas nine patients had a tissue expander. The average implant size was 375 ml (range, 325–450). Three patients developed seroma around the implant. One patient had mild erythema and two patients had delayed wound healing. Two patients developed partial nipple necrosis. One patient experienced infection and wound dehiscence mainly at the T-junction, and the vertical limb, which was managed by a re-do surgery, removal of the implant, and insertion of a tissue expander. The average follow-up was 14 months (range, 8–24). Conclusion Extended dermal sling is a safe, reliable, and effective option for immediate prepectoral breast reconstruction after mastectomy for patients with early breast cancer who have a large ptotic breast. It has a great advantage of being an autologous tissue with minimal complications and good esthetic results.

Advanced Autologous Lower Dermal Sling Technique for Immediate Breast Reconstruction Surgery in Small and Non-ptotic Breasts.

The online version contains supplementary material available at 10.1007/s13193-022-01524-8.

O77: DOES MESH IMPROVE PATIENT SATISFACTION AND HEALTH-RELATED QUALITY OF LIFE AFTER IMPLANT-BASED BREAST RECONSTRUCTION? A MULTICENTRE PROSPECTIVE COHORT STUDY

Abstract Introduction Biological and synthetic meshes may improve outcomes of immediate IBBR by facilitating single-stage direct-to-implant procedures. However, high-quality supporting evidence is limited, particularly regarding PROs. Method 2108 consecutive women undergoing IBBR at 81 centres were prospectively recruited between 2014-2016. Demographic, operative, oncological and 3-month complication data were collected. An 18-month questionnaire assessed PROs using the validated BREAST-Q and a five-point Likert scale rating of overall reconstructive outcome. The impacts of different IBBR techniques on PROs were explored using mixed-effects regression models adjusted for clinically-relevant confounders and including a random effect to account for clustering by centre. The reference group was two- stage submuscular reconstruction without mesh. Result 1470 participants consented to receive the questionnaire and 891 completed it. 67 patients underwent two-stage submuscular reconstruction; 764 patients received subpectoral reconstructions with biological mesh (n=495) synthetic mesh (n=95) or dermal sling (n=174). 14 patients underwent prepectoral reconstructions (introduced late in the study). Compared with two-stage reconstructions, no differences in PROs were seen in biological or synthetic mesh-assisted or dermal sling procedures (p&amp;gt;0.05). However, prepectoral IBBR patients reported better satisfaction with breasts (difference=6.63, 95% confidence interval[1.65–11.61], p=0.009). Outcomes were similar to those in the NMBRA 2008/9 cohort, which included submuscular procedures only. Conclusion This study does not suggest that mesh improves PROs of IBBR. It provides early data supporting improved satisfaction with breasts following prepectoral reconstructions. Future trials are needed to robustly evaluate prepectoral techniques. Abbrev IBBR: implant-based breast reconstruction, PRO: patient-reported outcome, NMBRA: National Mastectomy and Breast Reconstruction Audit Take-home message Although mesh-assisted techniques have become widely adopted, this large, prospective, multicentre cohort study does not suggest that mesh improves patient-reported outcomes of implant-based breast reconstruction compared with standard submuscular techniques. However, it provides early data to support improved satisfaction with breasts in the prepectoral setting, which now requires robust evaluation.

Transverse Scar Breast Reduction Technique with Suspended Dermal Slings for Correction of Severe Breast Ptosis and Macromastia

Introduction: Visible scarring over the breast mound isa disadvantage of the classic inverted-T breast reductiontechnique. The transverse scar breast reduction (TSBR) techniquewith suspended dermal slings limits the scar formationto the hidden inframammary crease.Patients and Methods: Sixteen female were included inthis study. We used the TSBR technique with suspendeddermal slings for correction of severe breast enlargement andbreast ptosis. Early postoperative complications were recorded.After 2 years, patients’ satisfaction about the surgery wasanalyzed.Results: All cases showed complete wound healing withintwo weeks except one case who showed partial ischemia ofthe nipple areola complex, which was managed successfullyby dressing changes. Regarding late complications, two casesshowed fat necrosis. However, overall patients’ satisfactionwas high.Discussion: Many surgeons use the technique of wisepattern inferior pedicle breast reduction for correction of hugebreasts with severe ptosis. Vertical scar breast reductiontechnique is not best indicated for correction of such condition.Transverse scar breast reduction limited the scars of thesurgery to the hidden inframammary fold and achieved stableand accepted results.Conclusion: Transverse scar breast reduction with suspendeddermal slings corrected huge breast enlargement andsever breast ptosis with a concealed scar restricted to theinframammary crease. Patients’ satisfaction about the outcomeof surgery was high after 2 years of follow-up.

Skin-Reducing Mastectomy and Pre-pectoral Breast Reconstruction in Large Ptotic Breasts.

Pre-pectoral breast reconstruction is increasingly offered to breast cancer patients, as the one-stage technique has proved surgical and oncological safety and aesthetic effectiveness. Nevertheless, there are limited data on outcomes after pre-pectoral breast reconstruction in large and ptotic breasts. The aim of the paper is to present the authors' experience in performing Wise pattern mastectomy with pre-pectoral implant and complete acellular dermal matrix (ADM) coverage as a single-stage procedure in patients with large ptotic breasts. A retrospective review of protective collected data from January 2017 to June 2019 of patients who presented with large and ptotic breasts undergoing skin-reducing mastectomy and immediate pre-pectoral breast reconstruction with complete ADM coverage and inferior dermal sling was performed. Oncological and surgical outcomes were collected. Satisfaction with reconstruction and related quality of life were evaluated through BREAST-Q questionnaire. Nineteen patients met the inclusion criteria. The average patient age was 55.6years, and the mean body mass index was 31.2. Mean follow-up was 23.2months from the initial reconstruction. One patient experienced seroma, and two cases of wound dehiscence at the T junction were observed and treated conservatively with no implant loss. All patients were satisfied with the final reconstruction. The Wise pattern skin-reducing mastectomy and pre-pectoral breast reconstruction could be offered to patients presenting with large and ptotic breasts. Future studies should better define long-term outcomes. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Dermal Sling Immediate Breast Reconstruction, Size Matters

Dermal Sling Immediate Breast Reconstruction, Size Matters

Visualized immediate breast reconstruction with dermal flap and implant.

Immediate breast reconstruction with dermal sling and implant has been known for almost three decades, but has not gained as much popularity as biological or synthetic meshes. The technique is well suited for women with large ptotic breasts. Its pre-operative planning is based on the Wise pattern mammoplasty and the actual surgery is rather straightforward and relies on the patient's own tissue and a standard breast implant. The aim of this paper is to visualize the dermal sling technique for immediate breast reconstruction. A dermal flap in combination with an implant seems to be safe, simple and reliable for immediate breast reconstruction.

Modification of the Superomedial Pedicle in Wise-pattern Breast Reduction: New Sling Suspension Technique to Prevent (Pseudo)ptosis

The combination of the superomedial pedicle with the traditional Wise-pattern skin resection has gained increasing popularity for its versatility and ability to achieve significant reduction of breast parenchyma and skin envelope. In this report, a reproducible new dermal suspension technique is described for cranial stabilization and fixation of the superomedial pedicle in Wise inverted T breast reductions to prevent pseudoptosis.

Modification of the Superomedial Pedicle in Wise-Pattern Breast Reduction: New Sling Suspension Technique to Prevent (Pseudo) Ptosis.

BACKGROUNDThe combination of the superomedial pedicle with the traditional Wise-pattern skin resection has gained increasing popularity for its versatility and ability to achieve significant reduction of breast parenchyma and skin envelope. METHODSThe author describes a reproducible new dermal suspension technique for cranial stabilization and fixation of the superomedial pedicle in Wise inverted T breast reductions to prevent pseudoptosis.RESULTSOne patient had a small dermal skin abscess caudal from the right areola as a tissue reaction on the remaining suture. The other peri- and post-operative cases were uncomplicated. Two patients experienced a two-week postoperative pain in the areas treated by liposuction. There was no reduced or increased sensibility of the nipple-areola complex. No signs of (pseudo) ptosis were seen. There was a 100% patient satisfaction rate. CONCLUSIONOur technique denoted to a direct support of the pedicle using a non-interrupted dermal suspension flap continued with the pedicle to be a medial, caudal and lateral support for the pedicle. The dermal sling reduced the anterior force generated by the pedicle. The pedicle enfolded by the dermal flap formed a vital basis for ingrowth in the surrounding tissue.

P043. Skin sparing mastectomy with immediate dermal sling implant reconstruction: an assessment of outcomes and patient satisfaction

Introduction: Skin sparing mastectomy (SSM) with immediate dermal sling implant reconstruction is an innovative option in breast cancer management and relies upon the use of autologous tissue to facilitate implant placement. This technique is particularly useful in patients with a high body mass index (BMI) and/or large ptotic breasts. Clinical and patient satisfaction outcomes in SSM with dermal sling implant reconstruction were retrospectively assessed in a London teaching hospital.

Short-term safety outcomes of mastectomy and immediate implant-based breast reconstruction with and without mesh (iBRA): a multicentre, prospective cohort study.

SummaryBackgroundUse of biological or synthetic mesh might improve outcomes of immediate implant-based breast reconstruction—breast reconstruction with implants or expanders at the time of mastectomy—but there is a lack of high-quality evidence to support the safety or effectiveness of the technique. We aimed to establish the short-term safety of immediate implant-based breast reconstruction performed with and without mesh, to inform the feasibility of undertaking a future randomised clinical trial comparing different breast reconstruction techniques.MethodsIn this prospective, multicentre cohort study, we consecutively recruited women aged 16 years or older who had any type of immediate implant-based breast reconstruction for malignancy or risk reduction, with any technique, at 81 participating breast and plastic surgical units in the UK. Data about patient demographics and operative, oncological, and complication details were collected before and after surgery. Outcomes of interest were implant loss (defined as unplanned removal of the expander or implant), infection requiring treatment with antibiotics or surgery, unplanned return to theatre, and unplanned re-admission to hospital for complications of reconstructive surgery, up to 3 months after reconstruction and assessed by clinical review or patient self-report. Follow-up is complete. The study is registered with the ISRCTN Registry, number ISRCTN37664281.FindingsBetween Feb 1, 2014, and June 30, 2016, 2108 patients had 2655 mastectomies with immediate implant-based breast reconstruction at 81 units across the UK. 1650 (78%) patients had planned single-stage reconstructions (including 12 patients who had a different technique per breast). 1376 (65%) patients had reconstruction with biological (1133 [54%]) or synthetic (243 [12%]) mesh, 181 (9%) had non-mesh submuscular or subfascial implants, 440 (21%) had dermal sling implants, 42 (2%) had pre-pectoral implants, and 79 (4%) had other or a combination of implants. 3-month outcome data were available for 2081 (99%) patients. Of these patients, 182 (9%, 95% CI 8–10) experienced implant loss, 372 (18%, 16–20) required re-admission to hospital, and 370 (18%, 16–20) required return to theatre for complications within 3 months of their initial surgery. 522 (25%, 95% CI 23–27) patients required treatment for an infection. The rates of all of these complications are higher than those in the National Quality Standards (<5% for re-operation, re-admission, and implant loss, and <10% for infection).InterpretationComplications after immediate implant-based breast reconstruction are higher than recommended by national standards. A randomised clinical trial is needed to establish the optimal approach to immediate implant-based breast reconstruction.FundingNational Institute for Health Research, Association of Breast Surgery, and British Association of Plastic, Reconstructive and Aesthetic Surgeons.

More evidence for implant-based breast reconstruction.

More evidence for implant-based breast reconstruction.

Implant-Based Breast Reconstruction with Autologous Lower Dermal Sling and Radiation Therapy Outcomes

Immediate breast reconstruction surgery (IBRS) with a sub-pectoral placement of implant improves quality of life of patients undergoing a mastectomy. Implant-based IBRS with autologous lower dermal sling (ALDS) procedure provides an effective surgical alternative to acellular dermal matrices. However, the influence of this procedure on radiation therapy (RT) outcomes remains unclear. This study aims at investigating post-surgery complications after 1 year in patients who have undergone IBRS-ALDS and RT. In this single-institution retrospective study, 78 implant-based IBRS patients with data available for a minimum of 1-year follow-up were stratified into group A (n = 40; IBRS) and group B (n = 38; IBRS + RT). Based on the use of ALDS procedure, group A patients were further stratified into sub-groups A1 (conventional IBRS; n = 21) and A2 (ALDS-IBRS; n = 19). Similarly, group B patients were sub-stratified into sub-groups B1 (conventional IBRS + RT; n = 18) and B2 (ALDS-IBRS + RT; n = 20). Clinical assessment and patient-reported outcome measures (PROMs) after 1-year post-surgery were conducted using Baker classification and BREAST-Q questionnaire, respectively. Patients in sub-group B1 exhibited higher percentages of overall major complications (41.6%) when compared to sub-group B2 (8.2%). Capsular contracture (12.5%) and reconstruction failure (20.8%) rates were higher for sub-group B1 vis-a-vis sub-group B2. Superior breast reconstruction outcomes with psycho-social well-being were observed in group B patients in comparison to group A (p < 0.05). Preliminary outcomes after a 1-year follow-up indicate that patients undergoing ALDS-IBRS exhibit reduced rate of RT-associated complications. IBRS-ALDS may obviate the need of ADMs in low-resource settings.

Breast Oncoplasty Surgery in Low- and Middle-Income Countries: Lessons From India

Purpose Breast cancer is the most common cancer in India, affecting all socio-economic strata. Despite its growing global acceptance, Breast Oncoplasty Surgery (BOS) remains nascent in India, necessitating local context-specific innovative delivery models for clinicians and the general public. Here, we present experiences from Orchids Breast Health Clinic (OBHC; Pune, India) with the implementation of BOS clinical services, training, and research and community outreach. Methods OBHC, a dedicated breast unit, has established the first dedicated BOS clinic in India, conducted hands-on training workshops for trainee surgeons, developed an MCh degree program in breast oncoplasty with the University of East Anglia (Norwich, United Kingdom), undertaken BOS research in Indian patients, and created outreach programs to popularize BOS. Results A cost-effective one surgeon–dual role concept wherein the same surgeon performs onco- and plastic surgery and one-stage implant-based breast reconstruction has been adopted. Since 2013, BOS cases included BCS (n = 440), breast reconstruction (n = 210), and therapeutic mammoplasty (n = 135). The unavailability of acellular dermal matrices has prompted the innovation of a surgical technique, termed Advanced Autologous Dermal Sling, which uses vascularized local tissue as implant cover. Significant improvement in postsurgery outcomes and protection against radiation complications has been observed. BOS hospitalization costs have been reduced by 50% thereby, which has led to high rates of acceptance (80%) of BOS in patients at OBHC. Young breast surgeons from across India and South Asian Association for Regional Cooperation countries have enrolled in the MCh degree program, which involves an embedded curriculum with online didactic modules and hands-on training workshops in Pune, India. Longitudinal follow-up after 1, 3, and 5 years postsurgery in the study cohorts is undertaken for post-BOS outcomes using clinical assessment (Bakers scale) and patient-reported outcomes measures (BREAST-Q questionnaire). Multiple research projects are undergoing peer-review before publication. To increase awareness of BOS among Indian women, community awareness campaigns with the theme of Losing Is Not an Option are underway via public talks, symposia, marathon, and op-eds in electronic and print media. Conclusion The OBHC model of Affordable Excellence in BOS, developed in the Indian context, can be extrapolated to benefit patients with breast cancer from other low- and middle-income countries. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST The following represents disclosure information provided by authors of this manuscript. All relationships are considered compensated. Relationships are self-held unless noted. I = Immediate Family Member, Inst = My Institution. Relationships may not relate to the subject matter of this manuscript. For more information about ASCO's conflict of interest policy, please refer to www.asco.org/rwc or ascopubs.org/jco/site/ifc . No COIs from the authors.

Combination of acellular dermal matrix with a de-epithelialised dermal flap during skin-reducing mastectomy and immediate breast reconstruction.

Introduction Patients with large ptotic breasts undergoing immediate implant-based reconstruction often require skin-reducing mastectomy to optimise the aesthetic outcome. However, healing complications, especially at the resulting inverted T-junction, leading to wound dehiscence, infection, skin necrosis, implant exposure and failed reconstruction have been widely reported. We present an innovative approach for immediate implant-based reconstruction combining porcine- or bovine-derived acellular dermal matrices with a de-epithelialised dermal sling to protect and support the implant, while improving clinical outcomes in this challenging group of patients. Materials and methods Demographic, tumour and surgical data were reviewed for patients undergoing Wise pattern (T-scar) skin-reducing mastectomies with immediate implant-based reconstruction combining porcine- or bovine-derived acellular dermal matrices with a de-epithelialised dermal sling. Results This technique was successfully employed to reconstruct five large pendulous breasts in four breast cancer patients with a median age of 50.5 years (range 34-61 years) who were not suitable for, or had declined, flap-based reconstruction. The acellular dermal matrices used were SurgiMend®, StratticeTM and Braxon® and the expandable implants were placed in the sub-pectoral (n = 3) and pre-pectoral (n = 1) planes. The technical steps and clinical outcomes are presented. One patient experienced T-junction breakdown overlying the de-epithelialised dermis without implant loss. Conclusion The combination of an acellular dermal matrix and a dermal sling provides a double-layer 'water-proofing' and support for the implants inferiorly, avoiding T-junction breakdown complications, since any dehiscence is on to well-vascularised dermis. Furthermore, the acellular dermal matrix stabilises the implant in the large mastectomy cavity (pocket control). This approach provides a viable option which facilitates mastectomy and immediate implant reconstruction in large-breasted patients.

Immediate breast reconstruction with a wise pattern mastectomy and NAC-sparing McKissock vertical bipedicle dermal flap

Preservation of the nipple-areola complex (NAC) in immediate reconstruction of ptotic and large breasts is surgically challenging. This article presents a modification of the inferior dermal flap ("dermal sling") to a vertical bipedicle flap with NAC preservation. This flap is well described in breast reductions but has never been described in a mastectomy setting. The study reviews data for a case series of 17 breasts in 11 women who underwent breast reconstruction with the new technique. The complication rate was 12%, thus indicating that the vertical bipedicle NAC-sparing flap should be considered a feasible option for breast reconstruction in women with ptotic and/or large breasts.

Abstract 77: Outcomes Analysis of Goldilocks Mastectomy and Breast Reconstruction: The Mayo Clinic Experience

PURPOSE: The Goldilocks mastectomy procedure involves local contouring of completely autologous breast tissue created by preserving and de-epithelializing the residual mastectomy flap. This technique provides patients with an option for post-mastectomy breast reconstruction alternative to simple mastectomy without reconstruction, complex autologous flap harvesting techniques, or the use of artificial implants. The purpose of this study was to provide outcomes data for 172 Goldilocks mastectomy procedures performed at a single tertiary academic center analyzing complication rate, relevant comorbidities, and adjuvant cancer treatment impacting functional and aesthetic outcomes. This is the largest series of Goldilocks mastectomy procedures to be reported to date. METHODS: Relevant comorbidities and complication data were collected. Patients who had prior surgical procedures before presenting to our institution were designated as such. Specific breast cancer pathology and previous breast therapy were indicated. Data relevant to the Goldilocks reconstruction at our institution were collected, including laterality of procedure(s), indication (i.e. prophylactic or therapeutic), whether a tissue expander or an implant was placed at the time of the Goldilocks procedure or at any point following the procedure, the number of procedures needed for the entire reconstructive regimen, and any specific revision procedures, if needed (i.e. fat grafting, mastopexy, augmentation, or scar revision). RESULTS: A total of 95 patients underwent reconstruction with Goldilocks procedure. 82.1% (78) of cases were bilateral, and 17.8% (17) were unilateral reconstructions. Breast cancer pathology results included: DCIS 27.3% (26), LCIS 5.26% (5), stage I 11.57 (11), stage II 23.1% (22), stage III 23.1% (22), inflammatory 5.3% (5), BRCA prophylactic 11.5% (11), other 2.1% (2), and recurrent cancer 6.3% (6). Pre-operative radiation therapy was given in 7.4% (7) of patients, while post-operative radiation therapy was given to 6.31% (6) of patients. 22.1% (21) of patients received chemotherapy and 17.8% (17) received hormone therapy. Previous breast reconstruction history included implant-based reconstruction in 3.15% (3), autologous 1% (1), multiple attempts 1% (1), and failed reconstruction 1% (1). Reconstruction types included Goldilocks-only in 58% (53) of patients, Goldilocks + tissue expander in 35.8% (34), and Goldilocks with implant in 10.5% (10). 45.3% (43) of patients underwent adjuvant fat grafting, 7.3% (7) underwent concurrent mastopexy, 5.2% (5) underwent concurrent breast augmentation, and 14.7% (14) had scar revision procedures performed at the time of Goldilocks procedure. Complications included: seroma 6.3% (6), hematoma 4.2% (4), cellulitis 4.2% (4), wound dehiscence 4.2% (4), DVT/PE 1% (1), readmission 1% (1), needed take back to OR 9.5% (9), needed explant 7.4 %(7), or other complications 3.1% (3). CONCLUSION: Goldilocks mastectomy procedures are a useful adjunct in reconstruction, and can also be used in implant-based reconstruction, providing a dermal sling to build an internal bra and scaffold for the implant. Patients who have relevant medical comorbidities or who decline traditional methods of reconstruction can greatly benefit from Goldilocks mastectomy. There may be substantial utility in considering Goldilocks procedures during pre-operative planning in patient-centered care along the reconstructive ladder, as this approach has the ability of being modified with additional procedures such as fat grafting or implant placement. J. Oliver: None. A. Chaudhry: None. S. Alsubaie: None. J. Martinez-Jorge: None.