Pyoderma Gangrenosum (PG) is a rare skin condition affecting approximately 3-10 per million of population and even rarer in the post-operative phase. It is difficult to diagnose, often confused for infection or fat necrosis and is ultimately a diagnosis of exclusion. We present a case in a middle-aged female who developed PG in the acute post-operative phase following immediate autologous DIEP breast reconstruction. The patient prior to a breast cancer diagnosis was otherwise well with no known auto-immune conditions. This patient underwent treatment to manage the PG and following a protracted treatment course the patients disease resolved. Pyoderma Gangrenosum is an important entity to be mindful of, specifically in breast reconstruction patients as outlined in the literature. It is imperative to rule out other more immediate life-threatening diagnoses such as cellulitis and necrotising fasciitis prior to diagnosing a patient with PG. The diagnosis should also be made in conjunction with