Breast cancer remains a significant cause of morbidity and mortality among women today. The transverse rectus abdominis myocutaneous (TRAM) flap has played a substantial role in the reconstruction of defects secondary to mastectomy. Although such reconstruction has not been shown to adversely affect survival or local recurrence, specific screening modalities for recurrence in this population of patients have not been delineated. Three patients were examined retrospectively at the authors' institution. They presented with local recurrences of breast cancer after mastectomy and TRAM flap reconstruction. All patients' recurrences were detected on physical examination, and all had the diagnosis of recurrent carcinoma made on biopsy of the mass. A review of the literature demonstrates that mammography, ultrasound, magnetic resonance imaging (MRI), computed tomography (CT), scintimammography, and biopsy have all been used as adjuncts to clinical examination in detecting recurrence. Subsequent treatment of recurrent breast cancer is determined by the results of a metastatic workup and the receptor status of the tumor. The most reliable form of diagnosis of recurrent breast cancer after TRAM flap reconstruction remains fine-needle, core, or open biopsy if indicated.