In 1998, the United States Federal Women's Health and Cancer Rights Act mandated insurance coverage for breast reconstruction after mastectomy and contralateral surgery for symmetry to improve access to these services. The United Kingdom National Mastectomy and Breast Reconstruction Audit revealed a doubling in rates of immediate breast reconstruction from about 10% to 20% over a 4 year period. The availability of breast reconstruction is an important factor and many of these women chose implant-based reconstruction. The most common type of breast reconstruction performed in the United States is immediate implant-based reconstruction. Plastic surgeons in academic practice are more likely to perform autologous breast reconstruction than those in solo practice in a community hospital. Awareness of breast reconstruction influences the patient’s ultimate decision regarding options for oncologic breast surgery. Breast reconstruction is an irreversible procedure, and it is important to optimize not only the decision-making process, but also to examine long-term patient satisfaction.