Free flap success rates, especially with autologous DIEP breast reconstruction, are approximately 99% in current practice. As such, we believe the new paradigm in autologous Breast Reconstruction is about achieving an aesthetic result for both abdomen and breast during the initial procedure. Stategies Strategies and how to implement each one effectively for DIEP flap reconstruction are outlined below. Abdomen; - Rectus plication – supra- and infra-umbilical - Midline progressive tension sutures - Subscarpal fat resection - Aggressive liposuction to anterior abdominal flap and flanks - Monsplasty and mons liposuction - Lateral and anterior upper thigh liposuction Breast; - Flap contouring and volume matching bilaterally in flap or to contralateral native breast - Projection sutures - Flap inset to chest wall to position the flap - Skin paddle at IMF or as neo-areola with lollipop style scar - Mastopexy or breast reduction for unaffected breast if required Laparoscopic assisted; - Reduced dissection of muscle, preservation of nerves - Limited rectus sheath dissection - Hernia and bulge rates The focus on achieving an aesthetic result of the abdomen and breast in a primary operation is pushing the boundaries by attempting to lower the number of revision procedures a patient needs following DIEP flaps and laparoscopic assistance in pedicle dissection can also add benefit to functional outcomes. The ultimate goal would be achieving both a successful free flap reconstruction and an aesthetic result in a single procedure. Skin paddle and dog ear revision can be performed under local anaesthetic in most patients.