Background: Immediate reconstruction after therapeutic or prophylactic mastectomy (IMR) is oncologically safe and confers improved quality of life. However, in Australia the IMR rate is only 17-18% (with considerable variation across states and sites). Factors influencing reconstruction decisions and complications are not well studied. Aims: To identify which patients in the KConFAb database have had mastectomy with or without reconstruction and factors influencing the uptake of immediate reconstruction. Methods: A retrospective analysis of the kConFab database was performed from January, 2010 to December, 2021 to identify the patients who have had mastectomy and whether the mastectomy was for cancer or for prophylaxis. Patient demographics and tumour characteristics, as well as treatment and complications were collected. Results: We included 477 patients in the study. 452 (94.5%) underwent IMR, 326 of which had an autologous reconstruction. 60.8% of patients had nipple preservation surgery. 72.5% of the patients lived in a metro region, 53.1% had private health insurance, and 89.5% were of Caucasian ethnicity. 41.4% of patients reported a complication and 23.7% required removal of a breast reconstruction. Patients living in Victoria were more likely to be offered an immediate reconstruction. Caucasian patients were more likely to have had an immediate reconstruction compared to those of middle eastern ethnicity. Conclusion: Patients living in remote areas of Australia and those of diverse background were less likely to access IMR. Further analysis of risk factors that may lead to higher rates of post-operative complications is required to improve service delivery and understand lived experience.