Objective: Immediate flap reconstruction following mastectomy in patients who may require adjuvant radiation therapy can be controversial. However, exposure of vital structure or defects too large for primary closure may necessitate immediate utilization of flaps. In this setting, both functional and cosmetic outcomes must be considered. Methods: We describe a case in which the patient required a wide excision of the axillary skin and a partial mastectomy, with a resulting large axillary and lateral breast skin defect. The ipsilateral pedicled parascapular flap was used for immediate reconstruction, with primary donor site closure. Results: Seven years postoperatively, she remained disease free, contracture free, with near-normal shoulder range of motion, and good cosmesis. Conclusions: Our case supports prior studies that have demonstrated the parascapular flap to have low donor site morbidity compared with other harvest sites. Our patient did not suffer from loss of functional range of motion or limitation in physical activity. It also demonstrates the flap's utility for lateral breast and axillary coverage and its durability in the setting of adjuvant radiation therapy.