Subcutaneous insertion of a gel-filled Silastic prosthesis to reconstruct a congenitally absent right breast was complicated by deterioration in skin circulation that necessitated removal of the implant approximately three hours postoperatively. No complications ensued when the same procedure was carried out three months later. Attention is drawn to the risk of interfering with skin circulation in patients with the rare anomaly of congenital absence of breast and nipple. The literature on this subject is reviewed. The author suggests that subpectoral implant may be a safer alternative in such cases.