Combined Goldilocks and Lateral Intercostal Artery Perforator (LICAP) Flap for Breast Reconstruction

Breast reconstruction can be challenging in patients who are poor candidates for reconstruction due to age, obesity, or existing 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, we introduce a novel approach combining the Goldilocks mastectomy and the lateral intercostal artery perforator (LICAP) flap. The Goldilocks technique repurposes the inferiorly based mastectomy flap to create central and medial aspects of the breast mound, while the LICAP flap utilizes the lateral chest fat roll to add lateral breast volume. We describe this combined technique and present our outcomes in four patients. All patients achieved satisfactory breast volume and contour, with no flap loss or major complications. Our experience suggests that this approach is safe, reproducible, and aesthetically advantageous, offering a practical solution for a previously underserved patient population.