This multi-centred study examined how 93 women due to undergo mastectomy had elected for (n=37) or against (n=56) immediate breast reconstruction. Initial semi-structured interviews were conducted prior to undergoing surgery whilst follow-up interviews 6 and 12 months later examined particpants' experiences of surgery and their views on their decision. Three decision-making styles were identified. Most women (76) reported making quick, 'instant' decisions, whilst 14 sought further information before making their choice. Three women deliberated over their options and found decision-making particularly difficult.Decision-making was influenced by the perceived salience of alternatives, prevailing 'norms' regarding surgical practice within each hospital system and interactions with health professionals. Experiences of surgery often failed to match patients' pre-surgical expectations and the process of adjusting to the impact of surgery continued throughout the following year, during which women contended with a range of problems including pain, scarring and adjusting to a reconstructed breast. However, most women reported themselves satisfied with their decision and justified their choices by focussing on positive aspects of their surgery.Whilst many women make a quick decision about breast reconstruction, research needs to explore ways of facilitating decision-making amongst those who find this decision particularly difficult.