Background: Abdominal free flaps are preferred for autologous post-mastectomy breast reconstruction. They offer superior long-term aesthetic and functional outcomes compared to implants and technical advantages over alternative autologous donor sites. Radiotherapy involving the abdominal wall is viewed as a contraindication to abdominal free flaps because of its adverse effect on the microvasculature and soft tissues. Case: A 61-year-old female with a previous history of left subcutaneous mastectomy, axillary node dissection, and adjuvant radiotherapy underwent a risk-reducing right mastectomy and bilateral DIEP flap reconstruction. She had a background of lower midline abdominal radiotherapy for non-Hodgkin’s lymphoma. Each hemi-abdomen was raised on a single, large, lateral row perforator outside the primary radiotherapy field. Epidermolysis occurred in the medial part of the right DIEP flap and was managed conservatively. There were no donor site complications. Discussion: This case follows a previously reported case from the same senior author of a successful bipedicled DIEP flap for revision of a failed implant reconstruction. This case further illustrates key considerations in patient selection, pre-operative planning, and surgical technique. The ideal candidate presents for a delayed autologous reconstruction after a mastectomy with adjuvant radiotherapy, requires a large volume of skin and fat, has otherwise favourable abdominal tissue, and lacks appropriate alternative donor sites. Surgery is planned in consultation with the treating radiation oncologist. The pre-operative CT angiogram is interpreted alongside radiation dose-distribution fields to select the optimum flap location, perforator(s), and pedicle. Additional measures may be taken to improve flap perfusion and reduce donor site complications. Conclusion: An abdominal flap from an irradiated abdominal donor site is feasible and may represent the best reconstructive option for selected patients.