Abstract Axillary clearance is still an integral part of the surgical treatment of breast cancer. Despite evolution in surgical technique, some accessory axillary structures such as the lateral throacic vein, may be sacrificied in order to achieve and adequate oncological clearance. Recent years have seen rapid advances in onco-plastic surgery and its involvement in breast cancer patients. As many onco-plastic procedures necessitate an adequate blood supply, structures which were thought to be expendable such as the lateral thoracic vein, are now viewed as useful vessels for success. We describe the use of the lateral thoracic vein as a salvage option in the Deep Inferior Epigastric Perforator (DIEP) flap and encourage surgeons to preserve this vessels when appropriate and safe to do so.