Despite significant advancements in early breast cancer detection, mastectomy remains a crucial treatment option for some patients. Immediate breast reconstruction post-mastectomy has emerged as an ideal procedure to minimise the physical and psychosocial impacts of mastectomy, striving for improved cosmetic results. The “enhanced Goldilocks mastectomy”, characterised by nipple preservation or grafting and utilising the 5th perforator anatomy, offers a novel approach. We review the technique and outcomes of two patients treated with Goldilocks mastectomy and free nipple grafting. We discuss the advantages, disadvantages, and real-world application of Goldilocks mastectomy in enhancing breast reconstruction outcomes and meeting patients' diverse needs.