Delayed breast reconstruction following mastectomy for cancer is widely accepted because of a high satisfaction rate. Immediate breast reconstruction offers an even more satisfactory solution, especially related to recovery and self-esteem. In our study, immediate breast reconstruction was performed for three indications: breast cancer, high risk for development of breast cancer and chronic cystic breast disease. Forty-eight consecutive patients with a mean age of 48 years were evaluated. In 37 cases malignant disease, in eight patients prophylaxis, and in three patients benign disease were the reasons for mastectomy. In 42 patients, primary reconstruction was performed, using tissue expanders, followed by prosthetic replacement. Of the other six patients, three were reconstructed with a definitive prosthesis and three with a musculocutaneous flap. At the end of the follow-up period, 42 patients had a definitive prosthesis and two patients had their breasts reconstructed with autologous tissue only. Four patients stopped the procedure following infection and extrusion of their implants. These infections accounted for an overall complication rate of 24%. After starting perioperative antibiotic prophylaxis from the 20th patient onwards, the complication rate was reduced to 12%. Thirty-three patients could be interviewed to assess satisfaction: nine patients were very satisfied, 18 were satisfied and six were moderately satisfied with the end result. Thus, 82% of the patients were satisfied.