AIMS: A retrospective analysis of the psychological advantages of immediate reconstruction (IR) against delayed reconstruction (DR). METHODS: A total of 121 patients who underwent different types of breast reconstruction were seen in the follow-up clinic and assessed for: anxiety, depression, body image, self-esteem, sexuality and satisfaction. RESULTS: Ninety-five percent of the patients who had IR preferred this technique and 76% of the DR group would have preferred IR. Anxiety and depression were decreased and body image, self-esteem and sexual feeling of attractiveness and satisfaction were significantly superior in the IR group compared with that of the DR group. CONCLUSION: Patients who had immediate reconstruction recalled less distress and had better psychosocial well being than those who had delayed reconstruction.