The midabdominal rectus abdominis myocutaneous flap is described in this review of 236 flaps in 223 patients. This flap is safe, reliable, and extremely well vascularized. It has been our flap of choice for purposes of reconstructing the moderate- or large-sized breast. In particular, the midabdominal flap permits restoration of fascial continuity over the entirety of the abdominal wall without the necessity for synthetic materials. A 2.2 percent incidence of hernias has been observed over a 4-year period. The flap is well suited to immediate reconstruction of the breast, particularly among the growing number of patients with antecedent radiation therapy.