Abstract Introduction: Skin sparing mastectomy with immediate autologous breast reconstruction has a positive psycho-social and sexual effect, however postoperative radiotherapy could adversely affect its cosmetic results. Patients and methods: This study included 24 female breast cancer patients underwent skin sparing mastectomy with or without scarifying NAC and immediate reconstruction by autologous TRAM and latissimus dorsi myocutaneous flap. They received adjuvant chemotherapy followed by 3DCRT, we evaluated them for skin complications and cosmoses. Results: Faint erythema or dry desquamation detected in 16 patients (66.6%), while 8 patients (29.2%) had moderate to brisk erythema. Two patients (8.3%) had skin edema and one patient (4.2%) had telangiectasia. Two patients complained from moderate pain Fat necrosis within the flap detected only in one patient (4.2%). Twentytwo patients (83.3%) had acceptable cosmoses while 2 patients had unsatisfactory cosmetic results. Conclusion: Postoperative radiotherapy is safe with acceptable rate of complications and very good patients satisfactions after skin sparing mastectomy and immediate autologous breast reconstruction. Keywords: Skin sparing; Immediate autologous reconstruction; Post-operative; Radiotherapy; Breast cancer