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Objective: To evaluate the ability of Diffusion weighted MR imaging (DWI), as a non-invasive sequence to differentiate between accepted post operative sequel and residual malignancy in breast cancer patients following different surgical procedures. Patients and methods: DWI in addition to the routine post contrast MRI was performed for follow up of 170 post operative breasts (6–24 months). DWI acquired using b values: 0, 850, 1000 and 1500. Analysis considered signal intensity (SI) at b 1000 and the ADC map and the mean ADC values. Results: Post operative changes were: Edema (n = 17, 10%), skin thickening (n = 25, 15.9%), seroma (n = 17, 10%), hematoma (n = 5, 3%), fat necrosis (n = 13, 7.6%), fibrosis (n = 8, 4.7%), and combined (n = 83, 48.8%). Residual malignancy found in 16.5% (n = 28) of cases. No significant difference was noted between DWI SI at b 850 versus 1000 and b 1000 versus 1500 (P > 0.05). Also no difference (P > 0.05) was noted between the mean ADC values of residual malignant masses and post operative sequel of fibrosis and fat necrosis. ADC map showed low SI in 30% of cases. Statistical analysis yielded sensitivity, specificity and accuracy of 92.8%, 75.6% and 78% for contrast MRI and 92.8%, 82.6% and 83.4% for DWI respectively. Conclusion: DWI enhanced the diagnostic performance of MRI in differentiating residual malignancy from post operative changes.