PURPOSE: The reconstruction of breast and upper body deformities in massive weight loss patients presents specific challenges to the plastic surgeon. In addition to significant breast ptosis and loss of breast volume, bariatric patients also have excessive lateral axillary and posterior truncal tissue that may require an upper body dermolipectomy for correction. A Wise pattern mastopexy was designed with a pedicled fasciocutaneous flap based on the intercostal artery perforators (ICAP) to correct breast ptosis, to restore breast volume, and to eliminate redundant upper truncal tissue. METHODS: Five massive weight loss patients were selected for mastopexy with ICAP flap reconstruction. A Doppler probe was used pre-operatively and intra-operatively to identify the ICAP vessels along the anterior axillary line. RESULTS: All five patients had stable and aesthetically pleasing results one, three, and six months post-operatively. There were no complications of infection, wound dehiscence, seroma, or hematoma. Furthermore, there was no evidence of flap loss or tissue necrosis. CONCLUSIONS: Mastopexy with autologous augmentation using the ICAP flap was found to be a reliable method of breast reconstruction with minimal morbidity in the massive weight loss patient.