Purpose of Review <p>Breast cancer is highly prevalent, impacting more women every year. Treatment may include surgery, radiation, and/or medication based on patients’ pathology and preferences. Nuances of treatment are difficult to discern with rapidly advancing therapies but warrant further clarity to ease patient-decision making. The aim of this review is to explore current reconstruction and radiation options and indications to better inform patient-provider teams.</p> Recent Findings <p>Reconstruction and radiation in particular are complex fields with some overlap. Reconstruction offers two primary options: autologous and implant-based, which have variable risk profiles and patient satisfaction. Post-mastectomy radiation is indicated for high-risk patients and can be given under standard fractionation or hypofractionation, which safely offers equivalent total dosing in reduced sessions.</p> Summary <p>Reconstruction with or without radiotherapy present complex paths forward especially with variable evidence. Optimal communication with patients requires discussion regarding evidence-based outcomes, patients’ goals, and expectation setting. Further research is required to better understand patient outcomes.</p>