A 77 year old male with a long history of Paget's disease presents with a large mass, of long duration, involving the left clavicle and upper chest wall. Preoperative evaluations are reviewed. The film emphasizes the technical aspects of successful resection of the tumor while preserving the neurovascular supply to the left upper extremity. Likewise, reconstruction with a large latissimus dorsi musculocutaneous flap is covered.