The free transverse rectus abdominis musculocutaneous (TRAM) flap has proven to be reliable means of recreating an aesthetic breast form after mastectomy. The purpose of this study was to determine whether neurotization of the free TRAM flap improved sensation of the reconstructed breast. Twenty six patients undergoing 37 free TRAM flap reconstructions were randomized to receive either a non-innervated or innervated flap. Innervated flaps had the T10 intercostal nerve of the TRAM flap repaired to the anterior sensory branch of T4 on the breast. Mean follow-up was 16 months and demographic analysis revealed no significant differences in patient age, height, smoking, radiation therapy, and nipple-areola reconstruction between patient groups (p>0.3). Sensory testing (Semmes-Weinstein monofilaments, 2 point discrimination, temperature) was performed by a single blinded examiner in a standardized pattern. Pre-operative sensation was not significantly different in the non-innervated and innervated groups. Post-operative pressure threshold and temperature discrimination were significantly improved in the innervated flaps (p<0.05). Non-innervated flaps displayed a pattern of decreasing sensibility from the periphery towards the centre while innervated flaps regained sensation throughout. Innervation of the free TRAM flap provides improved sensation to the reconstructed breast and is a simple, fast adjunct to breast reconstruction.