Pre-expansion of free flaps augments flap size dimensions and provides delay of tissue by opening "choke" vessels, thus augmenting the territories of adjacent angiosomes. Pre-expansion of free tissue transfers has been used for reconstruction of large soft tissue defects. A secondary benefit is that the donor site, traditionally treated by skin graft, can be closed primarily. Using conventional techniques for free flap pre-expansion, blunt dissection may risk injury to the pedicle. Using balloon dissectors a large optical cavity can be created quickly through an avascular fascial cleft. This allows endoscopic exploration of the optical cavity and confirmation of placement of the tissue expander. In addition, balloon-assisted endoscopic tissue expander placement optimizes the hysteresis effect of skin stretching and offers the possibility of immediate fluid inflation, which ultimately shortens the time for free flap expansion prior to microsurgical transfer.