Obese patients undergoing mastectomy have been documented to have improved outcomes after autologous reconstruction. The Goldilocks mastectomy (GM) has been proposed as a low-risk first-stage bridge to a second-stage definitive reconstruction. Goldilocks patients who desire autologous reconstruction with significant volume increase must consent to a second-stage flap, which typically requires a donor site with additional scarring and morbidity. We have found that many obese Goldilocks patients have significant excess upper abdominal subcutaneous tissue and are good candidates for a second-stage reverse abdominoplasty, which can provide them a completely autologous reconstruction. This approach adds minimal additional scarring, improves upper abdominal contour, and has a low rate of donor site complications. Here, we present 15 consecutive obese patients who underwent first-stage GM followed by second-stage reverse abdominoplasty, providing them with a completely autologous, low-risk reconstructive option.
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