Toward a More Definitive Goldilocks Mastectomy: Simultaneous Addition of the Lateral Intercostal Perforator Flap

The Goldilocks mastectomy was originally described as a safe technique that allowed for a single-stage autologous reconstruction in the patient who either was a poor candidate or was not interested in traditional multistage postmastectomy reconstructive approaches. This technique involved a skin-sparing mastectomy through Wise incisions and utilized the residual cutaneous flaps to create a breast mound. The final result was often less than optimal with regards to volume as the surgeon was limited by the amount of residual skin and fat that remained after the mastectomy. The best results were obtained in women with ptosis and an elevated body mass index. Here, we improve on these results by combining the Goldilocks mastectomy and the lateral intercostal artery perforator (LICAP) flap to provide a more definitive, autologous, single-stage, reconstructive option after mastectomy. Fourteen consecutive women underwent simultaneous bilateral Goldilocks mastectomy with bilateral LICAP flap augmentation. All patients successfully completed their reconstruction and were healed by 10 weeks postoperatively. The combination of the Goldilocks mastectomy and LICAP flap provides reconstructive surgeons an opportunity to provide a greater proportion of women a more definitive, safe, single-stage autologous reconstructive option after mastectomy.