Twenty-seven patients who underwent postmastectomy breast reconstruction using the ipsilateral upper transverse rectus abdominis musculocutaneous (TRAM) flap are presented. We believe that there are several advantages in using this flap instead of the lower TRAM flap. The ipsilateral upper TRAM flap has a stronger and more predictable blood supply, involves easier and stronger abdominal wall repair and less operating time with less blood loss, and has a very acceptable donor site.