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 in South Africa, characterised by an increasing prevalence and significant barriers to access reconstructive surgery for affected women. The Goldilocks mastectomy, introduced as a minimally invasive reconstructive procedure, addresses cosmetic and psychological concerns in patients with limited access to formal reconstruction. This study evaluated surgical outcomes and margin status following nipple-sparing Goldilocks mastectomy at a tertiary public hospital in South Africa. Methods: We performed a retrospective review of patients undergoing Goldilocks mastectomy at Helen Joseph Hospital between 2017 and 2024. Fifty patients underwent 95 mastectomies (predominantly bilateral for contralateral symmetrisation). Complications were graded according to the Clavien–Dindo classification. Margin status was obtained from histopathology. Logistic regression was used to explore factors associated with complications Results: The median age was 45 years (IQR 39–53), and the median BMI was 28.5 (IQR 26.0–35.3). 10 patients (20%, 10/50) experienced postoperative complications. The most frequent complications were haematoma (4%, 2/50), nipple necrosis (4%, 2/50), fat necrosis (4%, 2/50), nipple epidermolysis (2%, 1/50), and wound dehiscence (2%, 1/50). Reoperation rate was 14% (n=7). Positive margins were observed in 12% (n=6), of whom 2 required re-excision. Increasing body weight was associated with higher odds of complications (OR 1.09 per kg, 95% CI 1.02–1.21; p=0.036); a strong association was also observed with positive margins, although estimates were imprecise (OR 67.6, 95% CI 4.44–3690; p=0.009). Conclusion: This study in a public-sector cohort demonstrated that the Goldilocks Mastectomy offers acceptable oncological safety and complication rates, supporting its use in resource-constrained settings. Higher body weight was associated with increased complication risk, and thus careful patient selection is crucial.