This study evaluated patient's satisfaction with immediate breast reconstruction (IBR) with silicone prosthesis. Special attention is paid to the differences in satisfaction, and specific prosthesis related complaints of IBR after prophylactic and oncological mastectomy. All women who were operated on between April 1995 and May 1999 at the Erasmus Medical Centre, Daniel den Hoed Cancer Centre received 1 year following operation a self-report questionnaire, concerning their perceived advantages of and satisfaction with IBR, their prosthesis-related complaints and various psycho-social variables. The most important perceived advantage of IBR was not to have to wear an external prosthesis (95%). Despite the fact that one third of the patients had specific prosthesis related complaints, 80% was satisfied with IBR and 88% would do it again. There was no significant difference in satisfaction between the prophylactic and the cancer group. Overall satisfaction is mostly influenced by cosmetics (r = - 0.58), information (r = - 0.45) and specific prosthesis related complaints (r = - 0.39). Especially specific prosthesis related complaints are important for both the prophylactic and the cancer group. The majority of patients were satisfied with IBR after oncological or prophylactic mastectomy. However the findings of the importance of specific prosthesis related complaints should be taken serious for the information and care of patients.