A prospective case-control study of 81 patients has been carried out over 10 years comparing mastectomy with immediate reconstruction to mastectomy alone. The patients were matched for age (within 5 years), TNM stage, pathologic nodal status and operative procedure. After complete 10-year follow-up we have failed to demonstrate any long term difference in tumour behaviour. We conclude that immediate reconstruction is widely applicable and technically feasible without any long term effect on the development of local recurrence or metastatic disease.