Implant –based breast reconstruction with implants is the most widely used form of immediate breast reconstruction today. It provides a satisfactory result in most cases, and is the optimal choice for women wishing breast reconstruction and are not undergoing radiotherapy. Two stages allows symmetrization of the contralateral breast in the second stage, resulting in a more predictable outcome. It is usually accepted that the best patients for a suitable staged implant-based breast reconstruction with implants are those small or medium-breasted women with well-defined body shape, minimal breast ptosis and minimal or none skin resection with symmetric breasts. Large-breasted women treatment, usually involves skin resections that must be planned previous to mastectomy. We have observed that breast volume evaluation alone s not enough as an indicator for patient and technique selection. Mastectomy flaps thickness is also an important factor in immediate breast reconstruction planning, and breast volume and flap thickness are not in direct relationship.