Immediate breast reconstruction has become widespread in breast cancer patients since the eighties of the last century. Now the criteria for adjuvant chest wall radiotherapy are changing as the problem of interference between reconstruction and radiotherapy appears. The irradiation of a reconstructed breast increases complication rate and worsens long-term cosmetic results. If radiotherapy is needed, it should be given regardless of reconstruction and delayed, instead immediate, breast reconstruction is preferable. However, the necessity of radiotherapy is rather difficult to predict before surgery as the criteria arise from the definitive histopathologic examination. Consequently, the former reconstruction enthusiasm has been moderated. Oncologists should be familiar with immediate reconstruction issues in order to provide their patients with realistic information and not hinder reduction of negative esthetic side effects of oncological treatment. A survey of the most important literature concerning this issue is presented in the article.