Background: Several studies have evaluated patient satisfaction following breast reconstruction with the transverse rectus abdominis myocutaneous (TRAM) flap and implant based latissimus dorsi flap.However, the effects of regional radiotherapy after pedicled TRAM flap breast reconstruction and Implant based Latissimus dorsi flap on aesthetic outcome have not been previously extensively studied.Aim of the work: Compare the effect of radiotherapy on patients undergoing immediate breast reconstruction using either TRAM flap or implant based latissimus dorsi flap as a regard the aesthetic aspect and the patient satisfaction.Patients and Methods: A retrospective review was conducted on 53 consecutive patients who underwent immediate Breast reconstruction followed by radiotherapy in Menofia University, Plastic surgery and Clinical Oncology departments from August 2005 to July 2009.The patients were divided into two groups: Group I: Included 21 patients who underwent TRAM flaps Group II: Included 32 patients who underwent Implant based Latissimus dorsi flap.Patients were polled on their age, mastectomy type, laterality of reconstruction and adjuvant therapy.Aesthetic satisfaction based on breast shape, symmetry of breast shape, breast size, symmetry of breast size, breast scarring and breast sensation, hyperpigmention, flap contracture was assessed using a 5-point scale.Results: 53 patients with 21 TRAM flaps and 32 Implant based latissimus dorsi flap responded.In terms of overall aesthetic outcome, the TRAM group consistently rated better than the post implant based latissimus dorsi flap (p = 0.021).The TRAM group also had clinically and statistically significant less hyper pigmentation and flap contracture than the post Implant based latissimus dorsi group (p = 0.0001, 0.0001, respectively).Conclusions: We concluded that aesthetic outcome and patient satisfaction after radiotherapy for the reconstructed breast is highly influenced by the type of reconstructive procedure which was better by using TRAM flap procedure than using Implant based latissimus dorsi flap procedure.