Traditional Breast Reconstructive Surgery follows a standardardised pathway of oncological resection, reconstructive surgery and adjuvant chemo or radiotherapy. Reverse sequence breast reconstruction as the term suggests, reverses the treatment approach by allowing patients to have chemo or radiotherapy before their oncological resection and reconstruction six weeks after their initial treatment. Reverse sequence treatment of Locally Advanced Breast Cancer (LABC) with neoadjuvant radiotherapy (NART) carries the benefit of shorter overall treatment time as well as a single surgical procedure by combining mastectomy with immediate autologous breast reconstruction. A comprehensive review was conducted based on current literature in various databases including PubMed, Medline, EMBASE, Google Scholar, Cochrane Library and Web of Science. Articles within the last 30 years were included across all levels of evidence from randomized control trials and observational or qualitative studies and case series of >5 patients. This study aims to review the current evidence in reverse sequence breast reconstruction as well as to provide a reconstructive approach to improving patient outcomes with autologous free flap reconstruction in this setting.