Immediate reconstruction is becoming increasingly popular because it gives a better aesthetic result for breast reconstruction, and is more economical and convenient for patients than delayed reconstruction. Delayed breast reconstructions are still needed in 80% of mastectomized patients under 40 years and in half the women under 54 years—at least in Finland. This article discusses the technique of and contraindications for the free transverse rectus abdominis myocutaneous (TRAM) flap technique based on the author’s experience with over 300 free TRAM operations. The pedicled TRAM and the deep inferior epigastric artery (DIEA) perforator flap are also discussed.