Muscle sparing free TRAM flap. 32 yo 5′ 7″ underwent previous mastectomy and chemotherapy. Eight weeks post completion of chemotherapy and once her immune system had recovered she underwent a muscle sparing free TRAM flap reconstruction for the absent left breast. Note volume, shape, projection and overall contour of reconstructed breast. Nipple areolar complex creation and tattooing pending. Abdomen repaired with an in lay and an on lay mesh maintaining long-term strength to the abdominal wall in this athletic patient.