The present study was carried out in order to assess the feasibility and safety of chest wall reconstruction after majo/r full thickness chest wall excisions.In the present work, 19 consecutive cases who had presented by chest wall mass including 5 recurrent cases and one radionecrotic ulcer. The first 3 cases were repaired using polypropylene mesh alone for restoration of chest wall rigidity with eventually 2 cases died in the third and fifth postoperative weeks from flail chest, and respiratory failure. The remaining 17 cases were managed using methyl methacrylate (bone cement) polypropylene mesh sandwich in order to restore chest wall rigidity (in 14 cases) and by upward reinsertion of the diaphragm into the inner surface of the ninth rib (one case) and in two cases the defect was small (no bone cement was used). Soft tissue cover in the twenty cases was established using breast flap (4 cases), pectoralis major muscle flaps from both sides (2 cases), unilateral pectoralis major myocutaneous flap (2 cases) and combined with breast flap in (2 cases) latissimus dorsi myocutaneous flap (2 cases), latissimus dorsi muscle flap (2 cases), external oblique muscle flap (2 cases), combined latissimus dorsi muscle flap and external oblique muscle flap (one case). Transverse rectus abdominis myocutaneous flap in (one case) and omentum in (one case), with no reconstruction in the case who underwent upward reattachment of the diaphragm. In the last 18 cases, there were no mortality, no major postoperative morbidity and only 2 cases of minor wound infection.All had an acceptable cosmetic result except one case who had asymmetry of both breasts after using the right breast for coverage of a high medial defect. All the last 17 cases were discharged from the intensive care unit within 48 hours postoperatively. Stitches were removed on the tenth day postoperatively and all were discharged home 2 weeks after surgery, with no incidence of local recurrence including the single case who died 18 months postoperatively from metastatic chondrosarcoma.We conclude that polypropylene mesh alone was not enough to restore the chest wall rigidity, while methyl methacrylate polypropylene mesh sandwich was a reliable way of reconstruction. The soft tissue cover can be provided satisfactorily by different types of local pedicled muscle, myocutaneous and breast flaps with preference to options, which avoid change of position of the patient during surgery.