The advent of microsurgery has revolutionized the art of autologous tissue breast reconstruction. Microsurgical free tissue transfer allows the reconstructive surgeon to restore a naturally shaped breast without the constraints of pedicled flaps. Although the free transverse rectus abdominis myocutaneous (TRAM) flap has become the procedure of choice in microsurgical breast reconstruction, other popular donor tissue options include the deep inferior epigastric perforator (DIEP) flap, the deep circumflex iliac (Rubens) flap, and the superior or inferior gluteal myocutaneous flaps. In general, free tissue transfer has several advantages over pedicled flap reconstruction, including better flap vascularity, easier flap shaping and inset, and decreased donor site morbidity. The most popular recipient vessels used are the thoracodorsal vessels and internal mammary vessels. Other reported recipient vessels include the serratus branch of the thoracodorsal, the subscapular, and the thoracoacromial vessels. The thoracodorsal vessels are often used in immediate breast reconstruction because they are exposed during the mastectomy procedure, particularly following axillary lymph node dissection. In delayed reconstruction, however, many surgeons prefer to use the internal mammary vessels, to avoid repeat dissection through scar or fibrosis in the axilla. Many surgeons also prefer to use these vessels in immediate reconstruction. Advantages of the internal mammary vessels include more optimal flap placement with avoidance of lateral fullness and medial deficiency, and shorter required pedicle length. Access to the internal mammary vessels, however, requires increased operative time, and excision of a medial segment of costal cartilage, which carries the potential complications of pneumothorax, chest wall hernia or intercostal neuralgia. We report the use of a new, previously unreported, recipient vessel that has all the advantages of the internal mammary vessels, but avoids the necessity of costal cartilage resection and its associated morbidity. The anterior thoracic perforators of the internal mammary vessels are direct cutaneous perforators that emerge from the intercostal spaces, just lateral to the sternum, and form the vascular basis for the free or pedicled deltopectoral flap. These vessels are quickly and easily exposed, and are of adequate diameter for microsurgical anastomosis. The superficial location of these vessels avoids extensive dissection or rib removal, and their medial location allows optimal positioning of the flap. We present a series of free flap breast reconstructions using these recipient vessels and propose that the anterior thoracic perforator is an excellent new recipient vessel option in free flap breast reconstruction, enabling a more efficient reconstruction with significantly decreased morbidity.