Introduction: While several studies have evaluated patient satisfaction after breast reconstruction for mastectomy, specific parameters of satisfaction have not been defined. Methods: 400 women were retrospectively evaluated by anonymous questionnaire after implant, TRAM or latissimus dorsi flap reconstruction by a single surgeon. Patient demographics, procedure, adjuvant treatment, aesthetic and personal satisfaction, and lifestyle changes were assessed. A 5-point Likert scale indicated high (5) versus low (1) satisfaction. Results: 75 patients with 40 TRAM flaps, 3 latissimus dorsi flaps, and 44 implants responded. Autologous reconstruction patients rated aesthetic satisfaction higher than implant patients, including breast shape (4.4 versus 3.6), symmetry of breast shape (4.2 versus 3.5), breast size (4.4 versus 4.0), symmetry of breast size (4.2 versus 3.7) and breast scarring (4.0 versus 3.6). There was no difference in breast sensation (3.0 versus 2.8). Activities of daily living and exercise were not affected. Both groups reported that their breasts were not as important to sexual satisfaction after reconstruction as before, but that they remained important to self-image. Conclusions: Autologous reconstruction results in higher satisfaction ratings regarding breast symmetry and size, but not sensation. These differences do not appear to be related to changes in activity, exercise, sexual satisfaction, or self-esteem.