Breast reconstructions after breast cancer surgery are primarily performed to improve patients' quality of life. This study was performed to investigate patients' satisfaction with breast reconstruction and quality of life after pedicled or free transverse rectus abdominis musculocutaneous (TRAM) flap surgery and to evaluate the aesthetic result of the breast reconstruction both objectively and subjectively.Sixty-three patients (36 with pedicled flaps and 27 with free TRAM flaps) answered two questionnaires; of this group, 53 (27 with pedicled flaps and 26 with free TRAM flaps) participated in an aesthetic evaluation. The questionnaires consisted of two parts: one study-specific part concerning satisfaction with the result of the breast reconstruction, the other a standardized health-related quality of life part, the Short Form-36 questionnaire. The aesthetic examination consisted of an objective part in which various distances on the reconstructed and contralateral breast were measured. The volumes of the breasts were measured using a thermoplastic cast system. The softness of the breasts was assessed using applanation tonometry. A panel consisting of three plastic surgeons looked at four standardized photographs of each patient and evaluated the aesthetic outcome subjectively. The panel evaluated the breast reconstruction on 10 subscales. No statistically significant difference between the surgical groups was seen regarding the patients' satisfaction with the reconstruction. In the patients' self-assessment of the cosmetic outcome, the degree of symmetry was assessed higher in the free TRAM flap group. The health-related quality of life Short Form-36 questionnaire revealed no difference between the pedicled and free flap groups. Compared with a reference population, the breast-reconstructed group felt more tired and "worn out," less peaceful, more unhappy, and more restless. The free flap group reached a higher degree of symmetry in the objective evaluation and received generally higher scores from the three-member panel, compared with the pedicled TRAM flap group. A strong correlation between the patients' and the panel's evaluations of the cosmetic outcome was seen; generally, the panel's evaluation of the cosmetic result of the breast correlated with the satisfaction of the patients.