Background: This national prospective cohort study compared the patient-reported outcomes of breast cancer patients having post-mastectomy autologous reconstruction to those who had breast implants, in terms of aesthetic appearance, levels of psychological, physical and sexual well-being and overall satisfaction. Methods: Of 5,063 women who underwent immediate (IR; n=3,349) or delayed (DR; n=1,714) reconstruction between 1 January 2008 and 31 March 2009 in England, 2,923 women who consented were sent validated, procedure-specific 18-month follow up questionnaires. Outcome scale scores ranged from 0 (poor) to 100 (excellent); multiple linear regression was used to adjust scores for patient and treatment characteristics. Results: 2,289 women (78%) returned completed questionnaires (1,528 IR, 761 DR). For IR, mean overall satisfaction scores for the various techniques ranged from 67 to 85 (median 67 to 93). For DR, mean overall satisfaction scores ranged from 70 to 85 (median 75 to 100). For both groups, similar gradients were observed for the other outcome scales across techniques. Reconstruction using patientsí own tissues tended to have higher mean adjusted scores compared with those techniques using implants alone (p<0.0001 for aesthetic appearance, psychological well-being, sexual well-being, and satisfaction with outcomes for IR and DR groups). Conclusion: Women who underwent autologous reconstruction tended to report greater satisfaction than those who had an implant reconstruction. These results can inform patients of the anticipated outcomes of their selected surgery but further research is required to confirm whether autologous reconstruction is superior in general.