Restoration of shoulder abduction is a primary goal of brachial plexus reconstruction. While the spinal accessory nerve (SAN) is the preferred extraplexus donor for shoulder reinnervation, the phrenic nerve (Ph) is a valuable nerve that should not be neglected. Accessing the Ph does not require any additional incisions as it is in the surgical field during supraclavicular brachial plexus exploration. The Ph is near target nerves for shoulder function restoration. In addition, using the Ph spares the SAN to reconstruct other vital functions. Sacrificing the Ph leads to hindrances in pulmonary function that can be well tolerated in suitable patients over time. However, it should still be cautiously used in certain situations (e.g., infants and obese patients). With postoperative aerobic exercise, patients readily adapt deep breathing to induce voluntary shoulder abduction.