Background The Goldilocks mastectomy is a breast reconstruction technique that utilizes the remaining breast tissue post-mastectomy to create a new, smaller breast mound. For this reason, the Goldilocks technique is well-suited for patients with large, ptotic breasts. This procedure is often paired with free nipple grafting (FNG), a technique in which the nipple-areolar complex (NAC) is removed entirely and relocated as a skin graft. In cases where only one NAC can be preserved, the nipple can be split into halves and fashioned into two separate nipples prior to graft placement.

When FNG is employed in conjunction with Goldilocks mastectomy, it is often performed as a secondary procedure. However, the surgical risks and recovery time can be reduced when these procedures are performed concurrently. A single-stage operation can also allow for earlier radiation treatment or the avoidance of grafting on irradiated skin.

Case Presentation Here, we present the successful application of FNG in conjunction with the Goldilocks mastectomy in a single-stage procedure. The patient was a 55-year-old female with bilateral, retropectoral breast implants who wore a DD size bra. After presentation with microcalcifications in the left breast and diagnosis of ductal carcinoma in situ, bilateral mastectomy was suggested. The patient requested a reconstructive procedure in which her implants could be removed while still preserving the shape and aesthetics of her breasts. Because cancer was present in the left NAC, only the right nipple could be preserved for grafting. Therefore, single-stage, bilateral Goldilocks mastectomy with nipple-splitting and subsequent FNG was suggested as a treatment option. The procedure was explained to the patient, and she was informed of the associated risks. She chose to proceed with surgery. The procedure was successfully performed using a single-stage approach. The patient did not suffer any complications and had good wound healing, which led to a pleasing cosmetic result and eliminated the need to return to the hospital for further treatment.

Discussion The decision to perform FNG concurrently with a Goldilocks mastectomy provides several benefits. A FNG addresses the cosmetic impact of NAC removal, and the single-stage approach reduces overall recovery time, minimizes infection risk, and promotes a faster return to daily life. In this case, the patient’s desire for implant removal was accommodated while also providing total breast reconstruction in a single operation. The single-stage method helped to minimize postoperative complications and optimize the aesthetic outcome, ultimately yielding high patient satisfaction and improved quality of life.