Over the last 20 years, 245 patients have been treated with excision and reconstruction of congenital large and giant pigmented nevi at Children’s Memorial Hospital, Chicago, IL. The method if reconstruction is a function of size and location of the lesion, ranging from skin graft and serial excision to regional pedicle flap with or without the use of tissue expanders. In some regions where skin graft was the only available technique due to the shortage of adjacent flap skin, and where grafts resulted in unacceptable functional and aesthetic outcomes, other approaches have been considered. In these complex cases, expanded free flaps have been used with excellent aesthetic and functional results. Pre-expansion of free tissue transfers has been utilized for the reconstruction of large soft tissue defects. It not only provides a large flap but also minimizes the donor site defects. The final outcome can be a much superior aesthetic and functional result. Pre-expansion of the flap increases the dimension and provides “delay phenomenon” to the tissues by opening the choke vessels. In our experience, however, the expanded free flap may be prone to venous congestion, epidermalysis, and subsequent distal flap tip loss after the transfer. We have adopted the technique to place the tissue expanders adjacent to the flap to provide necessary tissue expansion to enable primary donor site closure rather than to expand the flap itself. It has enabled us to obtain large flaps based on known vascular territories without the undesirable consequence of expanded free flaps. We present 8 patients with congenital giant pigmented nevi reconstructed with the expanded free flap at Children’s Memorial Hospital, Chicago, IL, from 1997 to 2001, and go over the rationale for the choice of particular TE free flap used, the technical considerations, and the final outcome for each case. The choice of the expanded free tissue transfers includes: one parascapular flap for a complete forehead giant CPN, one anterolateral thigh flap to circumferential upper arm lesion, and 6 TRAM flaps to mid-upper back and neck, shoulder, and leg.