Internal mammary artery (IMA)-based pedicled perforator flaps can be used to reconstruct defects of the neck and anterior chest wall. Pre-expansion causes a possible delay phenomenon, improves flap survival, and decreases donor site morbidity. It also increases the area that can be covered. Pre-expanding can allow for perforator flaps that require a shorter arc of rotation. The pre-expanded internal mammary artery perforator (IMAP) flap is an excellent option for patients who have undergone multiple failed reconstructions and require large amounts of soft tissue while lacking other donor sites.