The GOLI procedure: goldilocks mastectomy with extended lateral intercostal perforator artery flap-a surgical technique for total breast reconstruction.

Breast cancer treatment may necessitate mastectomy; however, conventional reconstructive options are not suitable for all patients, particularly those with obesity and multiple comorbidities, due to increased risks of complications and prolonged operative times. We describe the GOLI procedure, which combines Goldilocks mastectomy with an extended lateral intercostal artery perforator (LICAP) flap, as a single-stage autologous approach for total breast reconstruction in this high-risk cohort. We demonstrate the feasibility and effectiveness of this technique in patients who were not candidates for implant-based or free-flap reconstruction. The procedure incorporates Wise-pattern skin reduction with de-epithelialised inferior dermal flaps to provide medial volume, alongside a laterally harvested LICAP flap that is mobilised and rotated to augment lateral breast fullness. This dual-plane volume redistribution enables improved contour, projection, and symmetry relative to patient body habitus. Both patients had uneventful postoperative recovery, with satisfactory cosmetic outcomes and no compromise to oncological safety or delays to adjuvant therapy. No flap loss or fat necrosis was observed. The GOLI procedure offers a reproducible, low-risk reconstructive option that avoids microsurgery while maximising autologous tissue utilisation. It may be particularly valuable in patients with limited reconstructive options and warrants further evaluation in larger, prospective studies.