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There are many ways to perform breast reconstruction after mastectomy, such as a two-stage operation using a tissue expander, filling the breast volume with autologous tissue, or immediate implant insertion. Tissue expander–based two-stage operations are widely used along with skin-sparing mastectomy or contralateral augmentation [1-3]. However, expansion may fail to occur as desired, or the patient may elect to have the expander removed without replacing it with an implant. Recently, as breast implant-associated anaplastic large cell lymphoma (BIA-ALCL)-related concerns have grown, patients fearing BIA-ALCL have been requesting expander removal without implant insertion [4-6]. In these cases, an area of concern for the surgeon is manipulation of the skin flap that has already been expanded. In particular, the base tissue of the expander often has a depression deformity due to the pressure of the expander. If only expander removal is done, with no implant insertion, the chest wall may look more concave than is the case immediately after mastectomy [7,8]. Here, we present a surgical technique that can be considered for patients who request only expander removal, and do not want the expander to be exchanged for an implant.

An alternative method to create a breast mound after tissue expander insertion: The modified Goldilocks technique