Autologous breast reconstruction has become increasingly popular in the past several years as more experience has been gained in the various techniques. Advantages to autologous reconstruction include improved shaping and symmetry, which also allow for a more natural reconstruction. The transverse rectus abdominis myocutaneous (TRAM) flap (free and pedicled) and latissimus flap are the predominant methods used although many newer donor sites have also been described. This article discusses techniques that allow the reconstructive surgeon to plan and execute the reconstruction of a natural breast reconstruction with autologous tissue.