In currently avai!able literature the optimal flap choice for reconstructing post mastectomy breast has not  yet defined. The  free TRAM  and  extended  latissimus  dorsi  flaps have  been described  for  breast reconstruction. However  comparison  between  them  has  not  yet  been described in our community. The current study was carried out to evaluate the two modalities in our society Patients and methods:  30 consecutive  patients who underwent immediate unilateral breast reconstruction were included in the study. 15 patients had undergone extended latissimus dorsi flap (group A) and the other 15 had undergone free TRAM (group B). All patients were evaluated operatively, clinically for complications, aesthetic results and patient's satisfaction during the mean follow up time 10.7(4-19) months for group A and 11.9(6-19) months for group B. Results: The mean operative time, blood transfusion requirements, hospital stay and time to start post operative adjuvant therapy (3.67 hours, 666.6cc, 11.6days and 26.6days respectively) in group A  patients were  significantly less than for group B (8.8days,1666.6cc,17days and 39.2days respectively) withp value < 0.01. The rate of complications in group B (one anastomosis revision, 2partialflap necrosis, one hernia and one fat necrosis/33.33%)  was higher than group A (one partial flap necrosis, one back scar disfigurement and 2seromas/26.67%). Higher patient's satisfaction was achieved in group A (93.3% satisfied to very satisfied) than in group B (79.9% satisfied to very satisfied) while aesthetic scoring was nearly similar in both groups. Conclusion: The extended latissimus dorsi flap could be as good as free TRAM regarding aesthetic  outcomes,  technically  feasible  flap  with  fewer  complications.  So  we  advocated offering the extended latissimus  dorsi flap as the 1st choice  for immediate  post mastectomy reconstructions to selected patients.