Patients known to be requiring radiation therapy after mastectomy present a complicated reconstructive scenario. If implant reconstruction is performed and then radiation is given, there is a higher rate of aggressive scarring around the implant which can cause pain and deformity. This is called “capsular contracture.” There is also a higher rate of implant based infection which can lead to removal of the implant and reconstruction failure. If a woman wants abdominal tissue reconstruction, performing it prior to radiation therapy can lead to unpredictable shrinkage of the reconstruction. For most women who are known to need radiation therapy after mastectomy, our general recommendation is to wait on any reconstruction until after the radiation therapy is completed. In some select patients, especially thin women with smaller breasts, initial reconstruction might be considered prior to radiation, but needs to be discussed with both the surgical oncologist and plastic surgeon.