Free tissue transfer is rarely used for cosmetic breast enlargement, but in certain cases of failed augmentation with implants, it may be a justifiable alternative. Our experience in treating bilateral capsular contracture with deep inferior epigastric perforators/superficial inferior epigastric artery flaps has been very favorable. Advantages include avoidance of implants and their related problems, more natural feel and shape, and ancillary abdominoplasty. Although the operation is substantially lengthier and more complicated than implant replacement, and the overall treatment cost much higher, we feel that surgeons who are skilled in perforator-based free tissue transfer should consider such procedures in the appropriate circumstances.