Breast reconstruction using autogenous tissue free flaps has come into favor because of greater reliability in blood supply and less flap morbidity. Traditionally, the choice of recipient vessel has been between the thoracodorsal vessels or the internal mammary vessels. Each has its advantages and disadvantages. We prefer the medial location of the internal mammary vessels, which allows for shorter flap pedicle and more optimal medial fullness in breast shaping. Unfortunately, the use of these vessels is often associated with an increased exposure time and potential morbidity from rib resection. We therefore began using the IMA anterior thoracic perforator as a recipient vessel in selected cases of microsurgical breast reconstruction, two years ago. We have been able to expose and prepare these vessels more expeditiously, and have found them to have adequate length and caliber. Furthermore, their superficial location eliminates the necessity of extensive dissections and rib removal. We present our experience using these vessels in microsurgical breast reconstruction in over 20 cases over the past two years, and explain why these vessels are now our primary choice for recipient vessel in free flap breast reconstruction.