Chronic tears or failed repairs of the subscapularis tendon may lead to painful dysfunction of the shoulder not responding to conservative treatment. If there is severe retraction of the torn subscapularis tendon, fatty degeneration of the muscle is advanced, and surgical repair of the musculotendinous unit is not possible, pectoralis major transfer may be indicated for the substitution of the insufficient subscapularis. The described technique consists of an attempted repair of the remaining subscapularis, the detachment of the entire pectoralis major tendon, transfer over the conjoined tendon, and transosseous fixation over a thin titanium augmentation on the medial aspect of the greater tuberosity. Pectoralis major transfer for isolated subscapularis tears results in improvement of function up to 79% of a normal shoulder. If an irreparable subscapularis tear is associated with an irreparable supraspinatus tear, the results are clearly less favorable, and pectoralis major transfer may not be warranted.