Routine magnetic resonance imaging (MRI) screening is not typically warranted in asymptomatic patients with a history of breast cancer and myocutaneous flap reconstruction due to the rare incidence of local tumor recurrence. We present a case of recurrent invasive ductal carcinoma along the contact zone between the transverse rectus abdominis myocutaneous (TRAM) flap and the native breast tissue that was incidentally detected on a routine high-risk screening-MRI of the breast in an asymptomatic patient with a history of breast cancer.