After a review of the literature, the authors attempt at a definition of the oncologically safe candidate to an immediate reconstruction after modified radical mastectomy for breast cancer. The analysis of the natural history of locally recurrent breast cancer indicates that the potential for its masking is negligible. Survival curves of patients submitted to immediate breast reconstruction are similar to those reported for historical controls. The ideal candidate for an immediate reconstruction is a stage I (negative axillary nodes) patient. As immediate breast reconstruction does not alter the prognosis of breast cancer patients nor does it harm the use of adjuvant therapies, the authors believe that even a well motivated stage II (positive axillary nodes) patient should be considered as a candidate for an immediate reconstructive procedure.