BACKGROUND: There is considerable debate in the literature whether to use a free TRAM or a pedicle TRAM for breast reconstruction, despite statistical favoring for the free TRAM. The national complication for the free TRAM and the pedicle TRAM for fat necrosis is 5% / 11% and hernia is 7% / 28% respectively. METHOD: A total of 41 women, ages 39 to 57, were used for comparison, none of which were smokers or obese. All had breast reconstruction using a TRAM (16 pedicle and 25 free). Follow up ranged from 11 months to approximately 2.5 years. RESULTS: The patients that had a free TRAM showed 0% symptomatic fat necrosis and 5% symptomatic hernia. The patients who underwent a pedicle TRAM had 15% and 36% incidence of the respective complications. CONCLUSION: The incidence of fat necrosis in the pedicle TRAM is a complication that brings about repeated and extra mammographies and biopsies to rule out whether this is a recurrence or just fat necrosis. Also the incidence of hernia repair for the pedicle TRAM is increased. These results definitely favor the use of a free TRAM for breast reconstruction