Case Report: A 55-year-old female underwent immediate bilateral DIEP flap breast reconstruction with venous anastomoses performed using 3.0mm couplers between the DIEA and IMV. On postoperative day four, the right flap developed sudden, spontaneous congestion. Urgent re-exploration revealed venous anastomosis rupture with an intact arterial supply. The pedicle had avulsed at the perforator level (distal to the coupler) with an extensive thrombosed segment extending into the flap. Due to the distal level of injury and absence of a viable SIEV for salvage, the flap was non-salvageable. Purpose: Vascular pedicle avulsion is an extremely rare, catastrophic cause of DIEP failure. Unlike thrombotic occlusion, mechanical rupture requires immediate identification of the "zone of trauma." This report highlights the challenges of distal avulsion and reviews salvage maneuvers for pedicle avulsions. Discussion: Incidence of pedicle avulsion in DIEP surgery is <0.1%, with venous ruptures more common than arterial.¹ Most cases result from mechanical forces (e.g. coughing/emesis) placing excessive tension on the pedicle. Salvage requires rapid re-exploration, debridement to healthy intima and tension-free reconstruction. While interposition vein grafts or SIEV "super-charging" are gold-standard techniques, avulsion at the perforator level significantly limits options if the intra-flap segment is compromised.² Prevention relies on maximal pedicle lengthening via intramuscular dissection and tacking the flap to the chest wall, mitigating movement-related tension. Conclusion: Venous pedicle rupture is a devastating event. While rare, surgeons must be prepared for microsurgical lengthening or grafting. Early recognition is vital, though distal avulsions at the perforator level carry a significantly poorer prognosis for salvage. References: 1. Lykoudis, E. G., et al. (2010). Microsurgery. Vascular pedicle avulsion in free flap breast reconstruction. 2. Davidson, A., & Simcock, J. (2020). Aust. J. Plast. Surg. Outpatient pedicle avulsion in DIEP free flap reconstruction.