A variety of useful recipient vessel options exist for delayed breast
reconstruction. The thoracodorsal vessels of the subscapular trunk, ho
wever, present the best option in immediate breast reconstruction, in
particular for the transverse rectus abdominis myocutaneous (TRAM) fla
p, because of their consistent availability and reliability. One funda
mental surgical advantage of the microvascular approach to breast reco
nstruction is the relative ease of obtaining consistently high-quality
recipient vessels throughout the axilla and anterolateral chest wall
to facilitate a predictably successful reconstructive outcome. This ar
ticle discusses the process of selecting the best vessels and the tech
niques for their dissection.