Perforator flaps represent the state-of-the-art in microsurgical breast reconstruction. UNC is one of only two centers in North Carolina offering such procedures. Unlike conventional TRAM flap reconstructions, use of perforator flap techniques allows for harvest of the lower abdominal tissue without sacrifice of underlying fascia and abdominal muscles. One or two blood vessels that “perforate” through the rectus abdominis muscle to supply the lower abdominal fat and skin are selected based on their size. These perforators are then gently dissected down to their source blood vessel by spreading the muscle, thereby preserving it. The abdominal tissue is then detached and transplanted to the chest where the blood vessels are reconnected using a microscope. The transplanted tissue is then surgically designed into a new breast.