More women than ever before are undergoing mastectomies secondary to increased awareness and screening. This increase has also caused a corresponding increase in number of breast reconstructions requested each year. Breast reconstruction after mastectomy is carried out to improve patient's quality of life. The increased demand for reconstruction has fueled recent advances in new techniques. Aside from foreign-body reconstruction such as implants, the methods now being used are related to autogenous donations and reconstruction. The most commonly used autogenous tissue for reconstruction is the transverse rectus abdominis musculocutaneous (TRAM) flap. The TRAM flap could be transferred either as pedicled or a free one with microvascular anastomosis. The following retrospective study was carried out to evaluate the two techniques.