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The threshold for patients with breast cancer to receive radiation therapy continues to be lowered. The author reviewed the literature to determine the clinical impact that the increasing use of radiation therapy has had on the management of patients with breast cancer who desire autologous tissue–based breast reconstruction.The MEDLINE database was searched for articles on breast reconstruction and radiation therapy published between January of 2008 and June of 2011. Abstracts of those articles were reviewed to identify articles that addressed the most pressing radiation-related issues facing reconstructive breast surgeons performing autologous tissue–based reconstruction. This subgroup of articles was reviewed in detail.Two-hundred eighty-five articles were identified. Seventeen articles were reviewed in detail. Nine articles provided level III evidence, mostly from retrospective comparative studies. Five articles provided level I (n = 2) or II (n = 3) evidence from high-quality, multicenter or single-center, randomized, controlled trials or prospective cohort studies. Three articles provided level IV evidence from case series and were included in the review because they offered a novel approach or perspective. Since the author's last review of the literature in 2009, there have been changes in the practice patterns in the approach to autologous breast reconstruction in patients who undergo radiation therapy.With the increasing use of radiation therapy in patients with breast cancer, future studies should seek to provide more meaningful data (level I and II evidence) to help guide clinical decision-making.Therapeutic, III.