This technique is like a combination of reconstruction and breast reduction. It is most commonly offered to women who have larger breasts and are choosing or require to have a mastectomy and want implant based reconstruction.

With this approach, the new breast mound typically ends up being significantly smaller than the natural breast, and often a breast lift or reduction is done on the other side at the same time or at a later date, to get balance. Sometimes the nipple areolar complex (NAC) can also be preserved with this technique, but most commonly it will need to be sacrificed. This version of a mastectomy takes considerably longer to perform due to the need to remove the outer layer of the skin of the lower part of the breast. It carries the same sorts of risks as any silicone based implant reconstruction, but has a slightly higher risk of wound complications. Most patients require a 2-3 night stay in hospital following this operation.