Combined Goldilocks and Lateral Intercostal Artery Perforator Flap for Breast Reconstruction

Breast reconstruction can be challenging in patients who are poor candidates for reconstruction due to older age, obesity, or comorbidities. These patients typically require a reconstructive approach that restores breast volume while minimizing operative time and surgical complexity. Many in this population present with significant lateral chest wall and axillary adiposity, which can create contour deformities and discomfort after mastectomy. To both reconstruct the breast and reduce lateral adiposity, the authors introduce a novel approach combining the Goldilocks mastectomy and the lateral intercostal artery perforator flap. The Goldilocks technique repurposes the inferiorly based mastectomy flap to create central and medial aspects of the breast mound; the lateral intercostal artery perforator flap uses the lateral chest fat roll to add lateral breast volume. The authors describe this combined technique and present their outcomes in 4 patients. All patients achieved satisfactory breast volume and contour, with no flap loss or major complications. This experience suggests that this approach is safe, reproducible, and aesthetically advantageous, offering a practical solution for a previously underserved patient population.