Purpose: Prophylactic mastectomy is emerging as an effective risk reducing treatment option for women at high risk for breast cancer. The purpose of this study was to evaluate the complication rate associated with breast reconstruction following prophylactic mastectomy. Methods and Materials: The authors conducted a retrospective review of the senior author's experience with breast reconstruction following prophylactic mastectomy at Georgetown University Medical Center from January 2001 to January 2006. All complications during the course of reconstruction were included. A complication was defined as an intervention (surgical procedure or intravenous antibiotics) performed for: capsular contracture; implant rupture; extrusion; hematoma; infection; seroma; necrosis of the nipple, areola, or flap; tissue expander malfunction; and wound dehiscence. Results: The authors identified 76 patients who underwent 96 breast reconstructions following prophylactic mastectomies. During the follow-up period (mean, 31 mo; range 2 to 69 mo) complications were identified in 9 (12 percent) of the 76 patients and involved 2 (2.1 percent) of the 96 breasts reconstructed. The rate of complication was significantly lower (P<0.001) in the tissue expander/implant reconstruction group versus the flap with/without implant group. Conclusions: Breast reconstruction following prophylactic mastectomy appears to have a lower complication rate than typically encountered after oncologic mastectomy reconstruction.