This study compared the revision surgeries in pre-pectoral implant-based breast reconstruction (PP-IBBR) after postmastectomy radiation therapy with photon versus proton. A total of 116 patients with PP-IBBR including photon (75, 64.66%) and proton (41, 35.34%) was included for analysis. Overall corrective surgeries were higher with photon (27.5% overall; 32.4% photon vs 19.5% proton, p=0.132). The odds of any revision surgery were nearly double with photon (OR=1.98), and the conversion to an autologous flap was significantly more likely with photon (OR=4.55, p=0.025). Multivariable analysis showed an increased tendency for photon therapy patients to require any revision surgeries (OR=1.62, p=0.359), autologous flaps (OR=5.97, p=0.049), fat grafting (OR=1.52, p=0.664) and scar revision (OR=4.51, p=0.273). The authors concluded that although not statistically significant, proton therapy is safer, with fewer revision surgeries, warranting larger studies and broader utilization.