Raynaud's phenomenon presents unique challenges in surgical procedures like breast reconstruction due to its vascular implications. A 64-year-old woman underwent unilateral mastectomy and immediate autologous breast reconstruction, facing complications attributed to vasospasm during DIEP flap surgery. The DIEP flap became congested immediately after the perforator was islanded without complete pedicle division. Consequently, the surgical team opted for the contralateral MS-TRAM flap to ensue successful breast reconstruction. Literature review reveals insights from similar cases. Cavadas reported a latissimus dorsi free flap reconstruction for lower limb trauma in a patient with Raynaud's phenomenon, utilising careful tissue handling, topical papaverine, warm saline and postoperative prostaglandin analogues. Jandali and Mehrara documented successful forehead reconstruction using an anterolateral thigh flap in a patient with Raynaud's phenomenon. However, these findings may not directly apply to DIEP flap reconstruction as demonstrated in this case. These cases underscore the importance of tailored approaches in patients with Raynaud's phenomenon during reconstructive surgery. Strategies like careful tissue handling and topical medications have shown promise in mitigating vasospasm-related complications. The variability in response highlights the need for an individualised treatment plan, emphasising thorough preoperative assessment and intraoperative adaptability to optimise outcomes.