As free flap breast reconstruction has become more common, we have sought to further refine donor sites. A woman is presented in whom a free flap from the low abdominal wall based on the superficial inferior epigastric artery and vein is used. This procedure results in total sparing of the rectus abdominis muscles and may be applicable in thinner women with smaller breasts, who cannot spare the larger ellipse of the conventional transverse rectus abdominis musculocutaneous (TRAM) flap. As we have sought to further refine breast reconstruction using autogenous tissue, microvascular tissue transfers are assuming a more important role. At the present time, it is possible to evaluate each individual woman for the most appropriate and available donor tissue to achieve a symmetrical reconstruction. In any given woman, it may be more appropriate to use the abdomen, hips, or buttocks, depending on the size and shape of the opposite breast and where the tissue can be most easily spared. We report here a woman in whom immediate breast reconstruction was performed using only the excess skin and fat of the lower abdominal wall pedicled on a unilateral superficial inferior epigastric artery and vein.