Background- Autologous breast reconstruction with the TRAM flap is traditionally based on either the superior epigastric vessels (pedicled) or the deep inferior system (free). Limitations exist in both techniques. The pedicled TRAM is at risk for variable fat necrosis. By utilizing the dominant arterial system, the free TRAM allows larger breasts to be constructed but relies on microsurgical technique and risks total flap loss. Another alternative is supercharging the flap by anastamosing the deep inferior epigastric vessels to either the internal mammary or thoracodorsal systems. We present a single surgeon?s experience with unilateral TRAM reconstructions supercharged to the internal mammary system in obese and non-obese patients. Methods- Fifteen consecutive patients underwent unilateral antilogous breast reconstruction with supercharged TRAM flaps to the internal mammary system between January 2001 and June 2003. The patients ranged in age from 28-61 years (average 49.4) and had an average body mass index of 28.5 (21.9-38.3). Left sided reconstructions were predominant (11/15). Before dividing the pedicle, the internal mammary vessels were exposed by resecting the cartilaginous portion of the 3rd rib. The artery was deemed appropriate for microvascular anastamosis in all cases. The vein was inadequate in one case. Vein grafts were not necessary. Results- There were no cases of complete flap loss or take-back for vascular thrombosis. One patient had minor fat necrosis. One patient developed an infection of the reconstructed breast but had patent DIE-IM vessels that passed through the infected site. Several patients had co-morbidities that increase the risk of free tissue transfer including prior chest radiation therapy and Sjogren?s syndrome. None of these patients had complications. Conclusion- Supercharging takes advantage of the DIEA dominant blood flow without the risk of total flap loss. We feel that the added benefits come with minimal additional morbidity. We report a qualitative increase in flow measured by audible doppler signals in all patients after the arterial and venous anastamoses were completed. Additionally, this technique was used in four obese patients (BMI >30) without complication.