Immediate breast reconstruction (IBR) after mastectomy is now quite frequent. To achieve this, an implant, in a complete muscular pocket, or a myocutaneous flap (latissimus dorsi, TRAM flap) can be chosen. Since 1983, 49 immediate breast reconstructions (11% of IBR) were performed with a myocutaneous flap in the Gustave Roussy Institute. In our experience, these techniques were principally performed because of the failure of conservative treatment (70%). Immediate complications were more frequently observed after immediate breast reconstructions with a TRAM flap (partial or minimal flap necrosis: 33%, infection: 13.5%). Late complications were more frequent in reconstructions with a latissimus dorsi flap: the prostheses were the main reasons (contracture III/IV: 25%, infection: 18%, deflation of the implant: 12%). The best long term results were described with the TRAM flap, and we now prefer this technique for immediate reconstruction with a flap.