The Deep Inferior Epigastric Perforator (DIEP) free flap is prone to venous congestion approximately 2-15% of the time. In such circumstances it is necessary to perform an additional venous anastomosis to improve venous insufficiency. Patients get additional venous anastomosis from sites such as the cephalic vein or external jugular vein which require an additional scar over the anterior aspect of the shoulder or neck, respectively. The lateral thoracic vein which lies at the lateral border of the pectoralis minor can be mobilised and is suitable for microsurgical anastomosis (approximately 2-3mm calibre). We present a case and approach whereby a patient who had undergone bilateral DIEP free flap breast reconstruction was taken back for unilateral venous congestion requiring an additional venous anastomosis. The lateral thoracic vein was identified without any additional scars and a 2.5mm venous coupler was used for anastomosis in addition to the deep inferior epigastric vein anastomosis. This improved the venous outflow from the flap significantly allowing salvage of the flap with minimal fat necrosis long term. Therefore, the lateral thoracic vein provides a reliable venous drainage and it can rapidly and safely harvested without any additional scars to the patient.