This article reviews immediate and delayed breast reconstruction with prosthetic implants, and the effect of irradiation therapy. Despite widespread use of breast conserving surgery for early breast cancer, many breast cancer patients still undergo mastectomy. Some of these patients choose breast reconstruction. Over the last 30 years, techniques for breast reconstruction have evolved significantly with new alternative techniques and improved surgical devises. Immediate or delayed breast reconstruction with silicone prosthesis can be an excellent option. Implant reconstruction may be single or two stage procedures. Traditionally, small breasts with minimal ptosis are suited for single-stage reconstruction. Large breasts or inadequate skin require expanders followed by implants. Minimal excision mastectomy and biological spacers are allowing larger breast single stage reconstruction and improved aesthetics for two stage procedures. With recent studies suggesting survival advantage of post-mastectomy irradiation, many candidates for breast reconstruction are receiving radiotherapy, which complicates healing after breast reconstruction.