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The authors conducted this study to determine the following: Does delayed breast reconstruction that requires surgical dissection in the previously operated on and/or irradiated axilla lead to a higher incidence of lymphedema? In patients who have developed lymphedema following mastectomy, does delayed breast reconstruction with autologous flap reduce the severity of the lymphedema?Four hundred eighty-two consecutive delayed autologous breast reconstructions performed at the authors' institution were evaluated. The authors evaluated the effects of flap choice, recipient vessel choice, previous radiotherapy, and previous axillary node dissection on lymphedema development after breast reconstruction. The authors also evaluated the effect of autologous breast reconstruction on the status of the preexisting lymphedema.Four hundred forty-four delayed breast reconstructions were performed using 394 free flaps and 50 latissimus dorsi flaps in patients with no lymphedema. Lymphedema developed in 16 cases (3.6 percent). The type of flap, the site of recipient vessel, previous radiotherapy, and previous axillary node dissection did not have a significant effect on the incidence of lymphedema after breast reconstruction. Breast reconstructions were performed in 38 patients who already had lymphedema: nine (23.7 percent) demonstrated significant improvement, and none demonstrated worsening of lymphedema after breast reconstruction.The incidence of lymphedema following delayed autologous breast reconstruction is low, and the use of thoracodorsal vessels or a latissimus dorsi flap, even in patients with previous axillary node dissection or irradiation, was not associated with a significantly higher risk of developing lymphedema. In patients who developed lymphedema following mastectomy, delayed autologous breast reconstruction may help reduce the severity of lymphedema.