Over the past 5 years, the senior author has performed 47 excisions and reconstructions of congenital giant pigmented nevi. The method of reconstruction ranges from skin graft and serial excision to regional pedicle flap with or without the use of tissue expanders. However, in a few selected patients with a large defect, the traditional methods are not effective. The senior author has relied on the expanded free flaps with excellent cosmesis. Pre-expansion of free flap not only provides a large flap previously not available but also eliminated the donor site defects. The final outcome is a much superior cosmetic result. We have adopted the technique to place the tissue expanders adjacent to the flap to provide necessary tissue expansion to enable primary donor site closure rather than to expand the flap itself. It has enabled us to obtain the largest flap available based on its pedicle vascular territory. We present 8 patients with congenital giant pigmented nevi reconstructed with the expanded free flaps from 1996 to 2001. The choice of the expanded free tissue transfers includes: two parascapular flaps to head and neck CPN and 6 TRAM flaps to mid-upper back and neck, shoulder, lower leg and foot, etc.