Bilateral breast reconstruction utilizing autologous free tissue transfer is a complex procedure with multiple options for donor tissue available. This study set out to compare the outcomes of patients undergoing bilateral breast reconstruction with muscle-sparing free TRAM flaps versus those undergoing bilateral reconstructions utilizing procedures which aim to minimize abdominal donor site morbidity in the form of deep inferior epigastric perforator (DIEP) or superficial inferior epigastric (SIEA) flaps. A retrospective review identified 31 patients and 62 free flaps for bilateral autologous breast reconstruction at our teaching institutions in Rochester, NY. Patients receiving procedures which aimed to minimize donor-site morbidity experienced a shorter length of hospital stay versus those patients undergoing bilateral free TRAM procedures (P = 0.0494 by t test and P = 0.0389 by parametric test). There was no significant difference in complication rates between these 2 groups. Other demographic and premorbid factors showed no difference between groups. Here, we demonstrate that bilateral autologous breast reconstruction with flaps which minimize donor site morbidity are a safe and effective option for bilateral reconstruction. Furthermore, patients who received bilateral breast reconstruction with abdominal wall sparing techniques (DIEP or SIEA flaps) had a significantly shorter length of hospital stay, with no significant difference in complication rates when compared with patients undergoing bilateral free TRAM procedures.