Flap prefabrication and prelamination are two closely related concepts. Clinical applications of flap prefabrication and prelamination are relatively new to the field of reconstructive plastic surgery. Although the two terms are often used interchangeably in the literature, they are two distinctly different techniques. Understanding their differences is helpful in planning reconstructive strategy. They are primarily used in reconstructing complex defects where conventional techniques are not available. Flap prefabrication starts with introduction of a vascular pedicle to a desired donor tissue that on its own does not possess an axial blood supply. After a period of neovascularization of at least 8 weeks, this donor tissue can then be transferred to the recipient defect based on the newly acquired axial vasculature. Flap prelamination, in contrast, begins with building a three-dimensional structure on a reliable vascular bed. This composite structure, once matured in approximately 2 weeks, can then be transferred to the recipient defect. This article describes in detail the principles, steps, variations, and applications of these two techniques.