We report a case of a 53-year-old woman with ductal carcinoma in situ of the right breast. Skin-sparing mastectomy and single-stage reconstruction of the right breast with a "buried" free deep inferior epigastric perforator flap was performed. Classic clinical monitoring was not possible due to the buried situation of the free flap. To assess the perfusion and viability of the perforator based free flap we performed a Tc-99m-sestamibi-SPECT/CT. The results confirmed the intraoperative clinical findings. Tc-99m-sestamibi-SPECT/CT may be a new tool for the postoperative evaluation of regional perfusion and viability of buried perforator based free flaps.