Breast reconstruction has greatly advanced during the past decade, offering the surgeon and the patient a choice between autologous tissue transfer and silicone implants, as well as between immediate and delayed reconstruction. In this retrospective study we reviewed the results of immediate versus delayed reconstruction with a permanent tissue expander, a method which is simple, fast and gives good aesthetic results. 19 patients had immediate reconstruction and 25 patients had delayed reconstruction. Capsular contracture (Baker II, III, IV) was more common with delayed (7/25) than with immediate (3/19) reconstruction; however, the difference was not statistically significant (p = 0.47). The overall complication rates and the final aesthetic results were similar in the two groups.