The development of the transverse rectus abdominus myocutaneous flap allowed for the single-stage transfer of a large bulk of soft tissue from the abdomen for use in breast or thoracic reconstruction. In situations where the tissue requirements exceed the blood supply of a single rectus pedicle, bipedicled and microvascular augmented flaps have been developed. Full-thickness defects of the thoracic cage present the additional problem of loss of skeletal stability. This case illustrates the use of a methyl methacrylate and marlex mesh plate, and a supercharged abdominal island flap for reconstruction of a massive full-thickness chest wall and axillary defect.