Breast cancer is the most common cancer diagnosed in women worldwide, and studies are now demonstrating an increased incidence in recent years. Despite this, mortality rates for breast cancer remain low, with many women living many years beyond their cancer diagnosis. Therefore, there is a need for durable reconstructive options. Approximately 40% of women diagnosed with breast cancer will undergo a mastectomy as part of their initial treatment plan. Breast reconstruction has been consistently shown to improve post-mastectomy quality of life. Despite this, breast reconstruction rates, both in the immediate and delayed setting, remain low. With advancements in microsurgery over the past few decades, autologous tissue reconstruction has become an attractive option for breast cancer survivors offering them the benefits of a more natural aesthetic and permanency over implant-based surgery. This review provides a report on avant-garde microsurgical breast reconstruction techniques and insight into some of the benefits and drawbacks associated with each surgical approach.