Background: Breast cancer patients treated with chemotherapy and whole breast hypofractionated radiation may experience acute and delayed cutaneous damage depending on a number of factors. Objective: Evaluation of acute skin toxicity of hypofractionated radiotherapy (HF Rth) in early breast cancer patients. Subjects and methods: We included 300 patients in a retrospective study at Clinical Oncology & Nuclear Medicine Department, Zagazig University Hospitals. Our patients received radiotherapy 40 Gray /15 fractions (40Gy/15Fr) in 3weeks, 5 days a week by use of opposed tangential fields to the whole Breast +/- regional lymph nodes followed by Boost of 10Gy/5Fr given to the tumor bed. Tumor bed was delineated using preoperative clinical data, cavity seroma or scar. Acute skin toxicity was assessed in all patients. Results: About 27% of patients (81 patients) had G0 acute skin toxicity 48.7% had G1 (146 patients), 13.3% (40 patients) had G2 and only 11% had G3. The results demonstrate a strong association between breast and boost volume, body mass index, bolus use, and acute skin toxicity. No significant correlation was found in patients between age, diabetes mellitus, hypertension and acute toxicity. Moreover, adjuvant chemotherapy is not linked to acute skin toxicity. Conclusion: Hypofractionated whole breast irradiation (HF-WBI) is feasible as well as safe, because of the low rate of moderate-high scores toxicity. Obesity and increase breast size makes acute skin toxicity more pronounced.