The internal mammary vessels are frequently used for free flap breast reconstruction and are typically dissected via resection of an entire rib cartilage. Resection of rib cartilage may cause increased postoperative pain or a depressed thoracic contour deformity. We have used a new, less invasive technique that does not resect rib cartilage and exposes the vessels within the rib interspace. Over a 3-year period, all breast free flaps performed with the rib-sparing technique were reviewed and compared with a group of flaps performed with the standard rib resection technique. The rib-sparing technique was performed for 74 flaps, with no significant increase in complications, including revision of anastomosis (3%), fat necrosis (11%), or flap loss (1%), when compared with a group of 125 flaps undergoing rib resection. This less invasive technique is reviewed in detail and may prove beneficial in regard to postoperative pain and incidence of chest wall deformities.