In general implant mastectomy reconstruction takes place in two stages. At the time of the mastectomy a tissue expander is inserted beneath the pectoralis major muscle and a piece of acellular dermal matrix or Strattice is inserted to provide support to the tissue expander. There are times, albeit rare, when I proceed with immediate insertion of mammary prosthesis. Patients who are candidates for immediate reconstruction with implant reconstruction are patients who are not ptotic, have previous implants, and do not have the presence of other comorbidities such as diabetes or obesity. Careful attention must be made to the skin flaps themselves to ensure viability. This is an example of a left mastectomy for breast cancer and immediate reconstruction with a mammary prosthesis.