Tissue expansion before tissue transfer is well described in the literature, be it for local, pedicled or even free flaps. There are also a handful of reported examples of tissue expansion of pedicled and free flaps after tissue transfer months to years following initial tissue transfer. The case presented below is by far the earliest use of tissue expansion of a free flap following initial tissue transfer. We present a case report of tissue expansion of a free musculocutaneous latissimus dorsi flap 2 weeks after initial surgery, and a review of the literature surrounding tissue expansion of free flaps following initial tissue transfer. Within 3-5 days following initial surgery, the distal tip of our patient’s free flap became necrotic. A tissue expander was placed under the central portion of the flap 2 weeks after initial surgery and expanded over the following 2 weeks. He was then taken back to theatre for removal of the expander and advancement of the latissimus dorsi flap. The patient discharged home 1 week after his final surgery. This case is by far the earliest reported case of using a tissue expander under a free flap following initial tissue transfer. The use of tissue expansion under a free flap is a potential option for difficult reconstructive situations.