The usual abnormal mammographic and sonographic findings encountered after reconstruction with autologous myocutaneous flaps for breast carcinoma, include fat necrosis, calcifications, lymphedema, and locally recurrent carcinoma. This case report describes a case of an intraductal papilloma occurring in a reconstructed breast in a 48-year-old woman who underwent a left-sided mastectomy for recurrent ductal carcinoma in situ followed by immediate reconstruction with a supercharged transverse rectus abdominal muscle flap. The role of imaging in the detection and management of occult or clinically palpable abnormalities in reconstructed breasts is discussed.