SCC of the head and neck is treated by surgery, radiation, and chemotherapy individually or in combination [
5]. However, its recurrence rate is between 60% and 70% for local recurrence or regional metastasis, and between 20% and 30% for distant metastasis [
6]. Lung metastases (66%) are the most common form of distant metastases of SCC, followed by bone (22%) and liver (10%) metastases. Metastasis to the chest wall has been rarely reported [
7]. Neoadjuvant or adjuvant radiotherapy is often performed for recurrent head and neck tumors, and 3 to 6 months after radiotherapy, reconstructive surgery should be performed carefully because the blood supply to tissues and fibroblast numbers decrease and delay wound healing [
8]. During wide tumor resection, reconstructive surgeons should fill dead spaces in the chest cavity and prevent respiratory complications such as flail chest. For skeletal reconstruction, various types of prostheses and metal plates are used to secure skeletal structures [
1-
4,
9]. With technical developments in microsurgery, free flaps have become the most important option for head and neck reconstruction. However, local flaps, including pectoralis major flaps are also indicated for patients with a poor general condition (i.e., when complete tumor resection cannot be performed). Although salvage operations are inevitable, free flaps are not indicated for these patients [
10]. The reconstruction of soft tissue defects of the chest wall can be performed using local, PMMC, latissimus dorsi (LD), or vertical rectus abdominis muscle flaps depending on the defect size. LD musculocutaneous flaps can often be used to reconstruct anterior or anterolateral chest wall defects, but it is difficult to approach the mid-sternum area [
2,
3]. PMMC flaps such as unilateral PMMC, bilateral PMMC, and PMMC turn-over flaps are used to reconstruct mid-sternal defects [
2,
3,
11], and PMMC flaps based on the thoracoacromial pedicle are usually used as muscle advancement or rotation flaps. PMMC rotation flaps provide a useful way of addressing sternal defects, but if a defect is too large to cover with a unilateral PMMC flap, bilateral PMMC flaps may provide an appropriate option. Additionally, detachment of the sternocostal head from the clavicular head of the pectoralis major muscle or separation of the insertion site of the pectoralis major muscle aids flap advancement [
3]. For larger defect coverage, a rectus abdominis flap or a free flap may be used. In the described case, reconstruction was attempted using PMMC flaps rather than a free flap, because the patient was an elderly cancer patient in poor general condition with recurrence. If a patient’s general condition is favorable, a free flap or omental flap is also considered a good choice for very large defect coverage [
2,
7,
10]. An axillary V-Y rotation advancement flap is a possible option for young patients, but is more appropriate for older patients with redundant skin, which is readily advanced, provides tension-free sutures, and does not cause severe postoperative shoulder motion restrictions. Unfortunately, there were no cases of young or female patients to refer to; therefore, we suggest studies be undertaken to determine the optimal treatment for such patients. We report this case treated using bilateral PMMC flaps, detaching the pectoralis major muscles from their origins and insertion sites, and using an axillary V-Y rotation advancement flap to maximize advancement after reconstruction of a large chest wall defect in an elderly patient without specific complications.