Patients with transverse rectus abdominis musculocutaneous (TRAM) flaps may develop physical findings, such as palpable masses, irregularities, and areas of increased tenderness that are suggestive of fat necrosis or recurrent malignancy. The purpose of this study was to evaluate these findings with mammography in an attempt to rule out recurrent malignancy in the autogenously reconstructed breast. Fifteen patients on whom mammography was performed as an aid in the evaluation of suspicious post-TRAM flap findings were reviewed. Common mammographic findings included calcifications believed to demonstrate fat necrosis, benign dermal calcifications, calcified hematoma, and clustered microcalcifications. Areas of increased or decreased density without calcifications were also identified and appeared to be related to surgical changes and fat necrosis. Twenty percent of patients had clustered microcalcifications, and 20% had detectable masses on mammography. One patient had a suspicious mass associated with clustered microcalcifications, leading to a biopsy that revealed fat necrosis. The majority of findings were consistent with normal fat within the TRAM flaps. This study supports mammography as a useful diagnostic tool in patients who have undergone TRAM flap breast reconstruction and who present postoperatively with suspicious physical findings.