BACKGROUND Recent studies have shown that patients undergoing immediate breast reconstruction after mastectomy have a higher rate of complications relative to patients undergoing mastectomy alone. Conflicting data exist on how these complications impact adjuvant treatment. We sought to quantify the additional risk associated with immediate breast reconstruction after mastectomy and determine how these risks influence adjuvant chemotherapy. METHODS A retrospective review of women undergoing mastectomy for breast cancer and immediate breast reconstruction between January 2007 and December 2012 was conducted. We abstracted clinicopathological variables and stratified women according to the type of reconstruction and presence of surgical complications. Additionally, time to adjuvant chemotherapy was assessed. RESULTS Overall, 56 of 199 (28%) women suffered 70 complications, of which hematoma, skin necrosis, cellulitis, or seroma accounted for 53 (76%) of the complications. The start date of adjuvant therapy was known in 116 (58%) of the women with invasive cancer. Overall, patients that underwent immediate breast reconstruction did not have delay in adjuvant treatment when compared to patients with no reconstruction (41 days vs 42 days, P = 0.61). Women with a complication did have a significantly longer interval to adjuvant chemotherapy when compared to those with no complications (47 days vs 41 days, P = 0.027). When further stratified by type of reconstruction, although there were differences in time to adjuvant chemotherapy, none of these reached significance (tissue expanders: 45 days vs 41 days, P = 0.063; flap reconstruction: 72 days vs 49 days, P = 0.25). CONCLUSIONS Immediate reconstruction after mastectomy does not delay additional cancer treatment. Overall, when complications do occur, adjuvant therapy is significantly delayed, though the median delay was only 6 days.