Purpose: Immediate breast reconstruction is increasingly performed post-mastectomy; however, traditional methods may be unsuitable for patients with comorbidities such as obesity and diabetes. This case report presents a novel hybrid procedure combining the Lateral Intercostal Artery Perforator (LICAP) flap with a Goldilocks flap for volume replacement, offering a solution for high-risk patients. Methodology: A 72-year-old woman with poorly controlled diabetes and obesity presented with a 7cm invasive carcinoma in the left breast. She underwent a nipple-sparing mastectomy followed by hybrid reconstruction using a LICAP flap for volume replacement and a Goldilocks lipodermal flap for added volume. Intraoperative indocyanine green (ICG) angiography was used to assess flap perfusion, and sentinel lymph node biopsy was performed via the same incision. Results: Histopathology revealed a 60mm grade 2 invasive carcinoma with clear margins and negative sentinel lymph nodes. The patient showed good postoperative recovery, with satisfactory cosmetic outcomes at the one-week follow-up. The surgical procedure was completed without complications, and the patient was recommended adjuvant radiotherapy and endocrine therapy. Conclusion: The hybrid LICAP-Goldilocks flap procedure provides a viable reconstructive option for high-risk patients. Combining the LICAP flap for volume replacement and the Goldilocks technique for subcutaneous fat preservation, this approach is safe, effective, and aesthetically pleasing, making it suitable for patients who are not candidates for implant-based or autologous reconstruction.