Background <p>Patient reported outcomes are key elements to be considered in breast reconstruction process. Microsurgery has gained increased popularity for breast reconstruction. We intended to compare different breast reconstruction options effect on patients’ satisfaction and quality-of-life (QoL), principally the deep inferior epigastric artery perforator (DIEP) flap, and evaluate comorbidities impact.</p> Methods <p>A cross-sectional observational study was conducted using BREAST-Q in Portuguese women with previous breast cancer, mastectomy, and submitted reconstruction in the last 10 years by our department. Demographic characteristics and comorbidities were also analyzed.</p> Results <p>We obtained 122 responses, in which 78.7% were autologous and 21.3% alloplastic reconstructions. DIEP flap was the most frequent modality (44.3%). Half of the patients had a microsurgical reconstruction. The average age was 51.23 years and mean follow-up 5.44 years. DIEP flap resulted in greater postoperative breast satisfaction (63.49 ± 21.83 vs. 54.25 ± 21.49; <i>p</i> = 0.023). The average BREAST-Q score was higher with DIEP flap (70.54) and immediate reconstruction (71.98). Globally, satisfaction with the breast and abdomen improved after reconstruction (<i>p</i> &lt; 0.001). BMI (<i>p</i> = 0.043) and being divorced (<i>p</i> = 0.027) independently predict lower BREAST-Q scores and psychiatric disease (<i>p</i> = 0.002) worse breast satisfaction, contrasting with DIEP flap (<i>p</i> = 0.026) that predicts increased breast satisfaction.</p> Conclusions <p>Autologous and immediate breast reconstruction have resulted in marginally higher satisfaction and QoL. DIEP flap remarkably evidenced significantly superior breast satisfaction, being an independent predictor for higher satisfaction. The surgeon should acknowledge that BMI, psychiatric diseases, and being divorced may negatively impact the result.</p> Level of evidence <p>Not ratable.</p>