Objective To assess the clinical effectiveness of breast reconstruction and the utility of the BREAST-Q patient-reported outcomes measure for routine patient care. Methods The BREAST-Q was administered to all patients attending a breast reconstructive service (n = 343) at a University Hospital at each visit. Results The BREAST-Q was easy to administer in a clinic setting, with a high participation rate (64.2% completing the minimum dataset of three BREAST-Qs). Pre-operatively, women with invasive cancer scored lower than those with DCIS or high-risk status (eg. mean psychosocial well-being scores 51.45 vs 63.74 vs 65.56, p < 0.05). At six months post-mound reconstruction the mean values for immediate and delayed timing of reconstruction were similar, with the change in quality of life from pre-reconstruction to this time-point post-reconstruction being greater in the delayed group (eg. mean improvement in psychosocial well-being scores for immediate 8.90 vs delayed 19.87, p < 0.05). Women with autologous flaps had greater improvements than women with implant-based reconstruction (eg. mean increase in psychosocial well-being scores 20.29 vs 9.58, p < 0.05). Breast reconstruction was highly effective in terms of improving psychosocial (mean pre-op 55.44 vs post-op 71.47, p < 0.001), physical (mean pre-op 69.82 vs post-op 74.78, p < 0.001), and sexual well-being (mean pre-op 38.74 vs post-op 54.17, p < 0.001), as well as satisfaction with breasts (mean pre-op 44.99 vs post-op 64.92, p < 0.001), in this non-selected cohort of patients. Conclusion Breast reconstruction is highly effective in improving the well-being of women undergoing mastectomy. The BREAST-Q is well suited for clinical effectiveness research and easily incorporated into routine patient care.